‘Energy Map Assessment’ Application.
Hi! Thank you for being willing to invest the time in yourself to book a call. I am looking forward to meeting with you soon! Please complete this prior to your Energy Mapping call. This gives a jumping point for the assessment and helps me determine if I am the best person to help you or not.
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Name (First and Last Name)
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What are you most interested in? Please tick ALL that apply.
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Free content
Self Study
Small Group Virtual Programs guided by Physician
1:1 (in person or tele-medicine) with Dr. Jenny Tufenkian ND
How did you come across our energy assessment form? Was it through;
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On a scale of 1-10, how would you rate your physical energy level? (10 being highest energy)
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On a scale of 1-10, how would yourate your mental clarity/abilityto focus and create?(10 being highest energy)
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On a scale of 1-10, how would you rate your emotional wellbeing? (10 being highest energy)
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Tell us about your physical symptoms and how they affect your life.
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What do you most want to experience instead, physically, mentally, and emotionally? What are your top health goals?
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What’s getting in the way of you reaching your health goals? (Be as specific and honest as possible.)
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What kind of health approaches have you tried in the past?
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Who in your immediate social circle will support you in your efforts 100 percent? Who are the ‘cheerleaders’ (or quiet loving supporters) in your life?
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What would you be able to accomplish, if you were feeling at your best?
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Anything else you would like to share?
How did you hear about Dr. Jenny?
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What Timezone are you in?
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Eastern
Central
Mountain
Pacific
Alaska zones
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