Customer Satisfaction Survey Form

Client Intake Questionnaire

Rows	Yes	No	Unsure	Sometimes	Often
Are you new to Spinal Energetics?
Are you currently experiencing stress?
Do you find it difficult to relax or slow down?
Do you feel disconnected from your emotions?
Do you feel connected to your emotions?
Do you experience reoccurring tension in your body?
Does your body remain tense even when you're trying to rest?
Do you spend time connecting with your body?
Have you experienced any physical trauma or accidents recently?

What would you like support with today?
Is there anything in your body that feels new, unfamiliar or simply worth mentioning today?
Should be Empty:

Your Alignment Assessment