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Calm Fairies PATIENTS
1.
How old are you?
2.
Do you identify as
Female
Male
Gender Neutral
3.
Why are you in hospital?
Asthma
Broken bones
Diabetes
Eating disorder
Encopresis
Surgical
Other
*
4.
How are you feeling now before the session?
(Required.)
1
2
3
4
5
6
7
8
9
10
Anything else you want to add?
5.
What is the most difficult thing for you right now?
6.
Would you like to do some calming activities?
Yes
No