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General Health and Wellness Questionnaire
First name
Last name
Birthday
Month
Month
Day
Year
Phone
Email
How do you feel today?
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Are there specific areas of your body where you feel tension or discomfort?
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Do you have any chronic health conditions? (Please specify)
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How would you rate your current stress levels? (1-10)
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How would you rate your current physical discomfort? (1-10)
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How would you describe your diet?
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Do you practice any form of meditation or relaxation techniques? (Please specify)
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What are your primary reasons for seeking energy healing?
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Have you experienced energy healing before? (If yes, please describe your experience)
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How did you hear about Layla & Ora Awakenings?
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Is there anything else you would like to share or feel is important for me to know before our session?
Date
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Month
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