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Wellness Professional 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 highest priority concerns at this time?*
Please indicate the approx. % change in revenue in your business for the most recent two weeks as compared to the two weeks prior.*
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
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 in the way of practicing more?*
What’s new for you in your SRI self practice?*
How many times have you brought your attention to and/or applied your Triad in your life since our last session?*
Anything else you want to share?