Body, Breath & Soul Questionnaire

 

Name *
Name
Address
Address
Do you have any chronic pain, physical limitations, or disabilities?
Are you taking any heavy medication? *
Do you have an active addiction?
Have you had a serious illness or major surgery within the last five years?
Have you experienced trauma, either physical or emotional, recently or in the past? *
Are you currently under medical treatment for any physical or mental conditions?
Are you currently experiencing an emotional or physical crisis? *
Are you currently pregnant or trying to get pregnant?
Do you currently have or have you had any of the following conditions in your lifetime: *
Please indicate other professionals you currently use:
Please indicate any of the following vehicles you use toward personal growth and development:

Instagram #love

I’m sure this incredible insect has a proper name but here at the Jordan home, we have dubbed it The Grande Rhino Beetle. #nature is amazing!
The KaingU campfire is my favorite. #kafueriver
Favorite place.
A perfectly lazy afternoon reading and watching the rain fall from our deck overlooking the #beauty of The Kafue River.
Other things to love about #kaingulodge — outdoor showers!! #love
Good morning, #beauty.