Name
First Name
Last Name
Email
example@example.com
How have you been feeling in your body this week?
(Notice sensations, energy levels, sleep, tension, or calm. what’s your body telling you right now?)
What have you done this week that supported your nervous system or helped you come back to center?
(Think: breathwork, walks, boundaries, saying no, slowing down, journaling, etc.)
Where did you notice the most resistance, stress, or emotional charge?
(What do you think your body was trying to communicate through that?)
How well did you honour your boundaries, rest, or energy this week?
(Did you over-give, hold back, or find a better balance?)
What’s one small win or sign of progress even if it feels subtle that you want to celebrate?
(Progress might look like awareness, saying no, or catching yourself mid-pattern.)
If your body or nervous system could ask for one thing this coming week, what would it be?
(More movement, more stillness, more connection, more time outside, etc.)
Is there anything else you would like to add?
SUBMIT
Should be Empty: