Weekly Pre-Class Survey

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:

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* 2. Response Week Number (If this is your first week of reporting choose "1" and so on):

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* 3. Gender

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* 4. Your Age (in years):

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* 5. Do you have pain in your body?

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* 6. If you answered YES to Question 5, please rate your pain with 1 being low pain and 5 being severe pain.

Rate the following questions on a 1 to 5 scale, 1 = strongly disagree and 5 = strongly agree:

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* 7. I feel energetic.

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* 8. I can balance myself well physically.

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* 9. I am generally feeling minimal pain.

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* 10. I feel calm, and my mind is clear.

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