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Initial Self-Assessment

A tool to help you become more aware of the current state of your body, and assess changes that occur from participating in this course.

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Question 1 of 10

Do you currently have any discomfort in your body? If so, list the most obvious uncomfortable sensations and grade them from 1-10 for severity. (10 is most severe)

Question 2 of 10

On a scale of 1-10, what is your overall energy level right now? (10 is full energy)

Question 3 of 10

On a scale of 1-10, how much tension do your eyes feel right now? (10 is very tense)

Question 4 of 10

On a scale of 1-10, how warm does your body feel in general (10 is HOT)

Question 5 of 10

On a scale of 1-10, how tense does your forehead and scalp feel? (10 is most tense)

Question 6 of 10

On a scale of 1-10, how affected does your body feel by the overall stresses in your life? (10 is highly affected)

Question 7 of 10

On a scale of 1-10, how loud is your average inhale and exhale. (10 is wheezing)

Question 8 of 10

Does your breath feel more...

A

Slow, relaxed, and full

B

Fast, tight, and shallow

Question 9 of 10

Does your swallow feel like it stops at the...

A

Upper Throat

B

Lower Throat

C

Chest Level

D

Stomach or Lower

Question 10 of 10

Do your hands and feet routinely feel cold?

A

Yes

B

Sometimes

C

Rarely

D

No

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