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:

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Sixteen years with this beautiful man today. I can’t wait to see what the next sixteen years hold for us. #happyanniversary #love
I turned 48 last month and I’ve been reflecting on some of the awesome decisions I’ve made over the last five years... first and foremost I stopped coloring my hair. Hear more in my story. #theschoolofsacredpractice
In three short weeks, The School of Sacred Practice begins. This year, we are diving into RECEIVING — join us for this heart-opening, healing and abundance-amplifying circle of women. Link in my profile. #theschoolofsacredpractice
This rose is giving me life this morning. It’s been a rough few days- the kind of days where you get course-altering news. The kind of days where conscious breathing and crying are necessary. And she just transmits her light and seems to say, “Don’t push. Stay centered. Let it unfold.” And so I will. #schoolofsacredpractice #love #rosemedicine