Initial Healing Pathway Assessment

Dear Client,

This questionnaire will help us determine the best starting point for your healing journey. Please rate each statement from 1-5:

1 = Rarely or Never

2 = Occasionally

3 = Sometimes

4 = Often

5 = Very Often

Name(Required)

Email(Required)

Phone(Required)

Physical Well-being (Body Pathway)

1. I experience physical discomfort or pain(Required)

2. I have concerns about my energy levels(Required)

3. I struggle with sleep or digestion(Required)

4. I'm interested in improving my nutrition(Required)

5. I feel physical tension or stiffness(Required)

6. I'm dealing with chronic health issues(Required)

7. I notice my body feels out of balance(Required)

8. I want to enhance my physical vitality(Required)

9. I'm seeking natural solutions for health concerns(Required)

10. I feel my body needs attention and care(Required)

Emotional Well-being (Mind Pathway)

1. I experience stress or anxiety(Required)

2. I struggle with limiting beliefs(Required)

3. I feel stuck in certain life patterns(Required)

4. I'm dealing with emotional challenges(Required)

5. I want to transform negative thought patterns(Required)

6. Past experiences still affect me today(Required)

7. I seek greater mental clarity(Required)

8. I want to build self-confidence(Required)

9. I'm going through life changes or transitions(Required)

10. I desire personal transformation(Required)

Spiritual Well-being (Soul Pathway)

1. I feel disconnected from my purpose(Required)

2. I seek deeper meaning in life(Required)

3. I sense energy blocks or stagnation(Required)

4. I want to enhance my spiritual connection(Required)

5. I feel called to explore energy healing(Required)

6. I experience intuitive insights(Required)

7. I seek inner peace and harmony(Required)

8. I want to understand my life's path(Required)

9. I feel drawn to spiritual practices(Required)

10. I desire deeper self-discovery(Required)

Additional Insights

Please share any additional information you feel is important:

1. What prompted you to seek healing at this time?(Required)

2. What area of your life needs the most attention right now?(Required)

3. What type of support do you feel would be most helpful?(Required)

Scoring Guide

Tally your scores for each section:

10-20: Mild focus area
21-35: Moderate focus area
36-50: Primary focus area

The highest scoring area often indicates your optimal starting pathway. However, your personal preferences and current situation are also important factors in determining where to begin.

Practitioner Notes

Primary Score

Total Body Score:

Total Mind Score:

Total Soul Score: