Explore the shifts you want to make as a result of your course experience. Take a moment to answer the essential questions below.

Name

First Name

Last Name

Tell us about what motivated you to take this course

Check all that apply to you:

Surgery

Chronic pain

Trauma

Want to know myself better

Desire for more mobility

Desire for more ease

Self-confidence/Self-trust

What would you like more of, less of, or to be different six weeks from now? (e.g. changes in your health, relationships, your profession or life in general)

What are your biggest challenges/blocks to having what you want?

What makes NOW the right time for you to heal and make positive changes in your life?

On a scale of 1-10, how committed are you to having less conflict and more ease in your life?

Is there anything else you would like to share?