HIPAA-Secure Referral Form

FOR PROVIDERS

Alicia Montgomery, C-IAYT — In Vitality Yoga Therapy
Commerce Township, MI

What Is Yoga Therapy?

Yoga therapy is an evidence-informed approach to supporting physical and emotional well-being through customized movement, breathwork, and mind–body practices.

Unlike group yoga or fitness-based classes, yoga therapy is:

  • Individualized

  • Assessment-based

  • Goal-oriented

  • Designed to complement medical treatment

Sessions integrate functional movement, breath science, and nervous system regulation to support the body’s natural healing processes.

Who I Work With

I support individuals who are experiencing:

Physical Conditions

  • Low back pain

  • Arthritis and joint pain

  • Hip, shoulder, or knee discomfort

  • Postural and mobility limitations

  • Balance and fall risk concerns

  • Effects of chronic stress on musculoskeletal tension

Emotional & Nervous System Conditions

  • Anxiety

  • Chronic stress

  • Sleep disturbances

  • Trauma-related dysregulation

  • Burnout or overwhelm

Medical Contexts

  • Cardiac rehabilitation support

  • Recovery from illness or injury (non-acute)

  • Long-term conditions requiring gentle movement and breath retraining

I work in collaboration with physicians, physical therapists, mental health providers, and integrative medicine practitioners to support continuity of care.

My Therapeutic Approach

My work blends:

🔹 Functional Movement

To improve mobility, strength, posture, load tolerance, and daily function.

🔹 Mindful Movement & Somatic Awareness

To cultivate interoception, reduce reactivity, and support emotional regulation.

🔹 Breath Science & Respiratory Re-education

To influence the nervous system, reduce sympathetic activation, and support pain reduction.

🔹 Yoga Philosophy (applied practically)

Supporting meaning, resilience, and self-understanding without spiritual imposition.

🔹 Client Insight & Collaborative Care

The client’s experience, intuition, and goals guide the therapeutic process.

Together, these allow for a whole-person and evidence-informed model of care.

What To Expect in a Yoga Therapy Session

1. Comprehensive Assessment

  • Breath patterns

  • Posture & movement quality

  • Strength & flexibility

  • Nervous system tone

  • Pain behaviors

  • Lifestyle and stress context

2. Targeted Therapeutic Interventions

  • Personalized movement sequences

  • Breath retraining

  • Mind-body practices

  • Nervous system regulation techniques

  • Education and self-management strategies

3. A Take-Home Plan

Clients receive simple practices to integrate between sessions for improved outcomes.

4. Ongoing Communication

With permission, I provide updates to referring providers to support coordinated care.


Referral Information

Referrals may be made by:

  • Physicians

  • PT/OT professionals

  • Psychologists and mental health providers

  • Integrative and functional medicine clinics

Clients may also self-refer.

How to Refer

Referring providers may:

  • Use HIPAA-secure form by pressing the button above or below.

  • Download and complete the fillable PDF referral form (BELOW) & give to the patient to bring to me.

  • Email alicia@invitalityyoga.com or call me 248-930-4539 directly to discuss

  • I can drop business cards or rack cards to your office to hand out to patients

Insurance

Yoga therapy is not currently billable through insurance.
Clients pay privately for sessions and can also use their HSA/FSA funds.

HIPAA-Secure Referral Form

Why Refer to Yoga Therapy?

Yoga therapy can support clinical outcomes by:

  • Improving mobility and functional strength

  • Reducing musculoskeletal pain

  • Enhancing balance and proprioception

  • Regulating the autonomic nervous system

  • Supporting adherence to rehabilitation and wellness plans

  • Reducing anxiety and stress-related symptoms

  • Complementing cardiac, PT, or mental health treatment

It is particularly beneficial for patients who:

  • Need a gentle, personalized approach

  • Struggle with traditional exercise models

  • Benefit from mind-body integration

  • Require nervous system stabilization alongside physical care

  • Have complex or comorbid conditions

Office location: We are inside of Prime PT Specialists

39630 West 14 Mile Rd.

Commerce Township, MI 48390