Original NS Blends Questionnaire

Sensamed

The Sensamed NS Blends questionnaire can be emailed to your client. Once they have filled it in, the results are emailed back to you. To send the questionnaire, enter your email and your client's email here:

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Client Email

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For the most accurate results, please answer each question.

Full Name

Do you experience any of the following:

Rows	0	1	2	3	4	5	6	7	8	9	10
Find it hard to relax.
Have difficulty handling stress.
Experience fatigue, exhaustion, or burnout.
Have a tendency to be nervous.
Experience headaches or migraines.
Have a tendency to be restless.
Experience symptoms or a condition affecting the nerves or nerve pain.
Carry a high stress load that negatively affects your health.
Experience physical acute or chronic pain.
Hold tension and/or tightness in the neck, back, muscles, or nerves.

Section 1 Score

Rows	0	1	2	3	4	5	6	7	8	9	10
Experience feelings of being worried, anxious, fearful, and/or panicky.
Have a tendency to be nervous, restless, and/or on-edge.
Feel uncomfortable in large gatherings or social settings.
Have a history of anxiety or panic attacks.
Have difficulty handling stress.
Hold tension and tightness in the body.
Experience anxious symptoms (racing heart, sweating, chest tightness, trembling)
Experience mental or emotional fatigue or burnout.
Feel stressed or anxious leading up to situations that make you uncomfortable or fearful.
Experience anxious symptoms in the body (stomachaches, headaches, muscle aches, pain).

Rows	0	1	2	3	4	5	6	7	8	9	10
Experience low energy.
Experience a sluggish metabolism.
Struggle to get out of bed in the morning.
Feel tired or unrested, even after napping or a 'good' night sleep.
Long periods of stress have left you feeling tired and worn out.
Often get sick or takes a long time to recover from illness or stressful situations.
Experience adrenal fatigue, exhaustion, or burnout.
Experience exhaustion, fatigue, low energy, or weakness.
Have a sluggish digestive system (slow digestion, constipation, cramps).
Body temperature tends to be on the cool side (feel chilly or too cold).

Rows	0	1	2	3	4	5	6	7	8	9	10
Find it difficult to relax.
Have lots (or even too much) energy.
Experience headaches or migraines.
Feel like you always need to be doing something.
Carry a high stress load that causes tension and tightness in the body.
Have an overactive cardiovascular system (racing heart, blood pressure, heart rate).
Have Sleep issues due to a busy mind (falling asleep, staying asleep, not feeling tired).
Have excess energy that needs to be burned off (trembling, restless, jittery).
Have a reactive digestive system (fast digestion, diarrhea, irritable bowel)
Body temperature tends to be on the warm side (feel sweaty or too hot).

NS Blends Questionnaire

Section 1 - Rate the following from 0 not at all to 10 strongly agree

Section 2 - Rate the following from 0 not at all to 10 strongly agree

Section 3 - Rate the following from 0 not at all to 10 strongly agree

Section 4 - Rate the following from 0 not at all to 10 strongly agree