Client Feedback Form

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* 1. Who was your practitioner?

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* 2. Which issue/challenge did you address?

Emotional challenge

Physical challenge

Pain challenge

Addictions challenge

Spiritual challange

Family challenge

Relationship challenge

Childhood challenge

Ancestral challenge

Birth challenge

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* 3. Which area of your body was affected by the physical or emotional condition? If physical, which part was problematic? If emotional in which area of your body did the stress present itself?

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* 4. Which belief or value sabotaged you in the past did you resolve during your session?

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* 5. How would you describe your experience of your session? Was it:

Gentle

Stressful

Stressful yet manageable

Traumatic

Liberating

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* 6. How did you feel before the session? Which emotions did you feel challenged by?

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* 7. How did you physically feel before the session? Did you have tension in your body?

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* 8. How do you emotionally feel after the session?

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* 9. How do you feel physically after the session?

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* 10. What was your life / previous issue like before the session?

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* 11. How do you feel | How is your life different from after the session?

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* 12. Give your practitioner a rating out 5

Ok

Good

Very good

Excellent

This was insightful and profound!

Ok

Good

Very good

Excellent

This was insightful and profound!