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Virtual Pre-Assessment Form
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Pre Session
Virtual Ener
gy TUNE UP
Assessment Form
Are you familiar with your 7 energy centers?*
YES
NO
MAYBE
Never heard of them and I'm curious to know more
Which of your energy centers do you feel is out of tune?*
Crown-Pineal Gland
Brow-Pituitary Gland
Throat-Thyroid Gland
Heart-Thymus Gland
Solar Plexus-Pancreas Gland
Sacral-Sexual Glands
Root-Adrenal Glands
What is your top current concerns in NON medical terms. Use body signals only., ex Pain in foot, feeling tired etc.*
How long have you had this concern?*
Rate your level of intensity*
Select one
1
2
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4
5
6
7
8
9
10
10+
What is your second top concern in NON Medical terms*
How long have you had this concern?*
Rate your level of intensity*
Select One
1
2
3
4
5
6
7
8
9
10
10+
What other concerns do you choose to share?*
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Tammy Hawskworth
Canada
e-mail me at: welloiledlifewithtammy@gmail.com
•
welloiledlifewithtammy@gmail.com
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