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Pre & Post Program Symptom Questionnaire

Tell us about yourself:

This symptom inventory will take about 15-20 minutes and is best completed on a larger device. It will be completed BEFORE you start the program *and* AFTER you complete your program.
Please allow adequate time, but know that you can start where you left off if you complete on the same device.
1.Participant Name
2.Inner Alignment Program Start Date
3.Healers providing Soul Retrievals during this program:
(Choose all that apply)
4.Please share about your CURRENT USE of emotion-altering substance:
Not at all (in the last 2 years)
Daily
Weekly
Monthly
Quarterly
Yearly
Prescribed psychiatric medications
Other Doctor-prescribed medications that alter your mood
Alcohol
Marijuana
Psychedelics (plant medicine, MDMA, Ketamine, Ecstasy, etc.)
Other Recreational drugs
5.Are you filling this Questionnaire out BEFORE your program, or AFTER you have finished the program?
6.What modalities have you tried and provided a positive impact on your healing path in the last 5 years?
Not Applicable - Did not use this modality
No impact (I used the modality and had no impact or symptoms worsened)
Slight
Moderate
Significant
Very significant
Talk therapy (CBT or DBT)
EMDR
Internal Family Systems therapy
Coaching/Spiritual Counseling
Psychiatric Medications
Reiki
Accupuncture
Yoga posture practice
Breathwork practice
Meditation practice
Alcoholics Anonymous (or similar addiction therapy)
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