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Wellness Check-In Form
View Past Submissions
Title of Check-In Entry
Name
How has your sleep quality been in the past 1 - 2 months?
Not Great
Fine
Excellent
Have you been able to follow the food & lifestyle suggestions that we discussed?
Not Very Well
Somewhat
Yes
Have you been taking the suggested herbs or formulations?
No
Yes
N/A, I did not receive herbs/formulation suggestions
How about digestion?
Not very good
Fluctuates
Digestion is great
Are you currently having difficulty with? What are the challenges?
Suggestions were too complex
Making time for myself
Access to food / cooking / ingredients
Life feels too busy
Other
Do you have any current imbalances that you would like to address / or are having a hard time managing?
Skin
Sinus / Congestion
Allergies
Weight management
Mind care
Joint / Muscle Pain
Not at the moment, I am feeling great!
What new, positive shifts have you observed in your life due to the changes you have been making?
N/A
What new, positive shifts have you observed in your life due to the changes you have been making?
Notes about any previous questions or other comments:
N/A
Notes about any previous questions or other comments..
Would you like me to follow up with you?
Yes
No, I will reach out on my own
Submit
Your content has been submitted
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