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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?
*
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
Please type your response here
*
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?
*
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)
*
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)
*
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?
*
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)?
*
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)?
*
Do you understand the
difference
between
the symptom
and
the problem
(Subluxation)?
Yes
No
What Phase of Subluxation are you in?
*
What
Phase
of Subluxation are you in?
Phase 1
Phase 2
Phase 3
How long do you think you have had Subluxation?
*
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?
*
Have you been
consistent
with your
adjustment programme
?
Yes
No
How often are you scheduled to be adjusted at this point?
*
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?
*
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?
*
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?
*
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?
*
What
chemical goals
with
health
and
life
do you have?
Improve diet or nutrition
Manage weight
Reduce reliance on medication
None currently
Have your family members had a Spine and Nerve System check-up yet?
*
Have your
family members
had a
Spine and Nerve System
check-up yet?
Yes
No
Have you attended a Best of Health MasterClass?
*
Have you attended a
Best of Health
MasterClass?
Yes
No
Do you take the time to read the 2 Minute Lessons?
*
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?
*
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?
*
Is there anyone who has been
especially helpful
?
Dr Christian
Muba
Swetha
Khush
Laura
Inndrani
Dan
Rigved
Thara
Please type your response here
Do you have any
suggestions
to
improve
our
services
to you?
How would you describe our educational efforts?
*
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
