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Embodied Wisdom Previsit Form

Please complete the form below at least 12 hours prior to your next session. I look forward to being with you!
*Indicates a Required Field

First Name*
Last Name*
What positive changes have you noticed since your last session?*
What are your main concerns at this time?*
Are you aware of your current weight?*
How much has it changed? (indicate direction with a + or -).
How much sleep are you getting (on average)?*
What is your energy level during the day on a scale from 1 to 10?*
1 2 3 4 5 6 7 8 9 10
How's your elimination?*
How is your mood?*
What % of your food is homemade?*
What cravings are you aware of lately?*
What’s your diet like these days?
Breakfast*
Lunch*
Dinner*
Snacks*
Liquids*
What kind of physical exercise have you engaged with since we last met?*
What kind of "self-care" have you engaged with since we last met?*
How many times have you practiced SRI since we last met?*
What, if anything, is the primary obstacle in the way of practicing SRI more frequently?*
What’s new for you in your SRI self practice?*
Anything else you want to share?