RCT / SESSION FEEDBACK Date MM DD YYYY Name * First Name Last Name Email * Emergency contact name and phone * Phone * (###) ### #### Stressed * 1-10 (1 low, 10 high) Anxious * 1-10 (1 low, 10 high) Depressed * 1-10 (1 low, 10 high) Conflict * 1-10 (1 low, 10 high) Knowing Purpose * 1-10 (1 low, 10 high) Personal Growth * 1-10 (1 low, 10 high) Empowered * 1-10 (1 low, 10 high) Peaceful * 1-10 (1 low, 10 high) Mental Clarity * 1-10 (1 low, 10 high) Emotional Health * 1-10 (1 low, 10 high) Physical Health * 1-10 (1 low, 10 high) Family * 1-10 (1 low, 10 high) Relationship * 1-10 (1 low, 10 high) Trusting Yourself * 1-10 (1 low, 10 high) Spiritual Growth * 1-10 (1 low, 10 high) Business / Career * 1-10 (1 low, 10 high) Social Life * 1-10 (1 low, 10 high) Financial Abundance * 1-10 (1 low, 10 high) Supported * 1-10 (1 low, 10 high) Loved * 1-10 (1 low, 10 high) Confident * 1-10 (1 low, 10 high) Happy * 1-10 (1 low, 10 high) Free * 1-10 (1 low, 10 high) Sleep * 1-10 (1 low, 10 high) Energy * 1-10 (1 low, 10 high) Thank you!
