HWF Research Project

Weekly Pre-Class Questionnaire

Dear Research Participant,
We are delighted you have agreed to participate in this important Healer Within Foundation research project!

The research is done through a simple survey completed by you before and after each class. Your responses will remain anonymous. We thank you for your time and valuable feedback!

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* 1. Your Information:

Your Email Address (this is your unique ID for research purposes only)

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* 2. Please rate the pain in your body today.

0 - No Pain

10 - Severe Pain

0 - No Pain

10 - Severe Pain

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* 3. Please rate your energy level today.

1 - Low

5- High

1 - Low

5- High

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* 4. Please rate your body's flexibility today.

1 - Rigid

5 - Flexible

1 - Rigid

5 - Flexible

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* 5. Please rate your physical balance.

1 - Poor

5 - Good

1 - Poor

5 - Good

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* 6. Please rate your mind's clarity.

1 - Stressed

5 - Calm and Clear

1 - Stressed

5 - Calm and Clear