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DEEP INTUITIVE HEALING SESSIONS
New Client Questionnaire

Please complete this questionnaire prior to our scheduled session.

All of your information is kept private and is used only to enrich your

Deep Intuitive Healing experience. We will never share or sell your personal information.

Have you been hospitalized in the last 12 months?
Are you currently suffering from a medical condition, illness, or injury?
Have you previously endured or are you currently enduring any serious mental or emotional health challenges?

Please consider the following and rate your experience accordingly.

I feel that my diet is balanced, nutritious, and well-suited for my constitution.

DietStrongly DisagreeDisagreeNot sureAgreeStrongly AgreeDiet

I feel that I regularly get enough exercise.

ExerciseStrongly DisagreeDisagreeNot sureAgreeStrongly AgreeExercise

I feel connected to my creativity.

CreativityStrongly DisagreeDisagreeNot sureAgreeStrongly AgreeCreativity

I feel comfortable in social situations and feel that I am able to spend enough time socializing.

SocialStrongly DisagreeDisagreeNot sureAgreeStrongly AgreeSocial

I regularly drink enough water.

WaterStrongly DisagreeDisagreeNot sureAgreeStrongly AgreeWater

I am able to frequently be in nature, and to feel my connection to nature .

Connection to NatureStrongly DisagreeDisagreeNot sureAgreeStrongly AgreeConnection to Nature

It is easy for me to focus.

FocusStrongly DisagreeDisagreeNot sureAgreeStrongly AgreeFocus

I am generally happy with life and feel good about my current life experience.

Life OverallStrongly DisagreeDisagreeNot sureAgreeStrongly AgreeLife Overall

In which of these activities do you partake?

Select All That Appy

Thank you for completing this questionnaire. All of your information is kept private and is used only to enrich your Deep Intuitive Healing experience. We will never share or sell your personal information.

If you have any questions, please email us at deepintuitivehealing@gmail.com

Thanks for submitting!

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