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Progress Evaluation #1
Step 1 of 24
4%
Name
*
First
Last
*
What
positive changes
have you noticed with your
overall health
since starting your correction programme?
Better sleep
Increased energy
Improved mood
Less pain / discomfort
Better focus / concentration
Improved digestion
Improved posture
More mobility / flexibility
Fewer headaches
Greater freedom of movement
Improved balance
*
What
other
changes in your health have you noticed, which you may not have linked to your
correction programme
?
*
On a scale of 1 to 10, how would you rate your
total health
level of improvement?
*
Would you say the
improvement
of your
spine and posture
is... (please tick one)
Progressing at the speed you expected
Taking longer than you expected
Occurring much faster than you expected
*
What are your
health goals
at this point in your care? (tick what you want)
Correct & eliminate symptoms / body signals
Improve function of organs and body systems
Reach potential / optimal health / best of health
*
Have we done a good job explaining your
correction programme
? In other words, do you feel that you understand why you are getting adjusted?
Yes
No
*
Has the doctor fully explained the
cause of your problem (Subluxation)
?
Yes
No
*
Do you understand the
difference
between
the symptom
and
the problem
(Subluxation)?
Yes
No
*
What
Phase
of Subluxation are you in?
Phase 1
Phase 2
Phase 3
*
How long do you think you have had
Subluxation
?
1 Week
1+ Weeks
1+ Months
1 - 2 Years
2 - 5 Years
5+ Years
10+ Years
20+ Years
*
Have you been
consistent
with your
adjustment programme
?
Yes
No
*
How
often
are you scheduled to be
adjusted
at this point?
1x a week
2x times a week
3x times a week
4x times a week
1x per fortnight
1x a month
*
Do you know why it is important to keep your
adjustments in rhythm
?
Yes
No
*
What
mental goals
with
health
and
life
do you have?
Improve mental clarity or focus
Reduce stress
Increased motivation
Not currently
*
What
physical goals
with
health
and
life
do you have?
Improve posture
Increase flexibility or mobility
Enhance physical strength
Not currently
*
What
chemical goals
with
health
and
life
do you have?
Improve diet or nutrition
Manage weight
Reduce reliance on medication
Not currently
*
Have your
family members
had a
Spine and Nerve System
check-up yet?
Yes
No
*
Have you attended a
Best of Health
MasterClass?
Yes
No
*
Do you take the time to read the 2
Minute
Lessons?
Yes
No
*
What
other services
at BodyWell would you like to know more about?
Nutrition
Weight loss
Fitness and physical conditioning
Quality sleep
Stress reduction
Greater energy
Stronger immunity
Raising healthy children / grandchildren
*
Is there anyone who has been
especially helpful
?
Dr Christian
Dr Pat
Dr Tracy
Aleyna
Shivi
Inndrani
Zeshan
Raine
Roman
Carl
Mihaela
Do you have any
suggestions
to
improve
our
services
to you?
*
How would you describe our
educational efforts
?
Excellent, I've learned a lot
Helpful and interesting
Still leaves some questions unanswered
Could be significantly improved
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