VIGEO Health - Emotion Session Form
Full Name
Email
example@example.com
Age
Date
/
Month
/
Day
Year
Date
If you have had previous Emotion Code or Body Code Sessions recently, what has gotten better? (Mention severity scale or symtoms, etc)
What's the loudest problem you are facing right now? Specific chronic pain, emotional issues, etc.
Severity 1-10 of this issue? (10 being the worst)
Is there a second issue you would like to address?
Severity 1-10 (10 being the worst)
Is there a third issue you would like to address?
Severity 1-10 (10 being the worst)
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