Mystic Meadows New Client Intake Questionnaire

1

Name* This field is required.

Full Name

First Name + Last Initial

Anonymous

2

Name

First Name

Last Name / Initial

3

Phone Number

Please enter a valid phone number.

4

Email

example@example.com

5

What Best Describes You?Project manager, Small business owner, Retired teacher, Full-time parent, etc.

6

Before Eustress. . .* This field is required.What were you feeling/struggling with?

7

After Eustress* This field is required.What changed? What feels better now?

8

One Specific Win You Can Point To* This field is required.If you can, add a number (e.g., ‘fell asleep 30 min faster,’ ‘neck pain down from 8/10 to 3/10’) in 'Other'.

Sleep Improved

Less Pain/Tension

More Calm/Focus

More Energy

More Relaxed

Faster Recovery After Workout/Stressful Days

Other

10

ESA Stage (if you've taken the Executive Stress Audit)

Didn't Take It Yet

Stage 0 - Distress

Stage 1 - Overdrive

Stage 2 - Strain

Stage 3 - Recovery

Stage 4 - Eustress

11

Recommend Eustress* This field is required.

Yes

No

Maybe Later

12

How Likely Are You To Recommend Eustress?* This field is required.

13

Add Media?A quick phone selfie or video is perfect.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

14

Permission To Share?

Yes, Eustress AVL can use my words/media for website, social, and print.No, keep private (use this as feedback only).

15

Did You Receive Anything Of Value In Exchange For This Testimonial?

YESNO

16

What Did You Receive In Exchange For This Testimonial?

17

Terms and Conditions* This field is required.