Client Questionnaire


Here is the client questionnaire, work through it and be as truthful as possible. We believe many aspects in our lives connect and influence seemingly seperate aspects of who we are, this is why we need honest answers. Going forwards, we will take the pace, depth and direction as appropriate to yourself, so please don't be put off by some of the questions. The questions will range from sleep, to behavioural patterns, exercise and food, to just highlight a few things. If you've any questions then there is a section at the end where you can add them, or you can wait until your first appointment where we will be talking about the information you provide here. 

Name *
Please type your date of birth as such: 01021990 (Basically with no spaces)
Why do you exercise? *
Select all that apply
How would you describe your food choices? *
Select all that apply
If this is irregular please shed some light on the situation.
Does your sleep go interrupted? *
Mindfulness and Mindset
Do you take time out for yourself? *
Do you have any mindful practices? *
Your emotional temperament: *
Your emotional temperament:
I'm often fairly happy
I'm a peaceable person
I get frustrated easily
I have a loose control over my emotions
I can show my anger quickly
What do you make of the following statements? *
What do you make of the following statements?
I'm shy and I think it shows
I'm confident, but it's for show
I'm comfortable with who I am
I'm accepting of who I am
I'm empathic
How do you sit with these statements? *
How do you sit with these statements?
I enjoy my life
People are pretty much always against me
I can do anything I want if I put my mind to it
Others make me anxious
There is good and bad in everyone
I have a blessed life
There are a lot of nasty people in the world
There is so much love in the world
I'm constantly bored/underwhelmed
I never get the right opportunities in life