Natural Healing Assessment

Full Name *

Email *

Date of Birth *

Phone (optional)

Have you experienced major trauma throughout your life? *

Do you experience discomfort or pain throughout your body? *

Where Is the Pain? (tick all that apply) *

BackNeckShouldersMigrainesJointsInflammationConceptionDigestion / GutEmotionalOther

What have you tried to help you through this discomfort before? *

DoctorsChiropractorPhysioEnergy HealingOther

What changes are you most wanting to see in your life? (tick all that apply)  *

FamilyHealthLifestyleRelationshipsMotivationPeaceCareerMoney

Is there anything else you wish to let Trish know? (optional)