Personal Wellness Form

Every person is unique, and so is every session.

This short wellness assessment helps us better understand your current challenges, stress patterns, and areas where you may be feeling out of balance. Your responses guide us in selecting the sound therapy protocol that best supports your goals.

There are no right or wrong answers—simply answer honestly based on how you feel today.

Why We Ask These Questions

Your responses may reveal patterns related to:

• Stress and nervous system regulation
• Emotional well-being
• Mental clarity and focus
• Sleep and recovery
• Areas of energetic imbalance

We’ll use this information to personalize your session and provide recommendations that best support your wellness journey.

Zen Waves Intake Form
Name
Do I feel safe and grounded in my life? (RT)
Do you struggle with fear or insecurity? (RT)
Do I have a stable foundation in my finances, home, and relationships? (RT)
Am I allowing myself to experience joy and creativity? (SC)
Are you connected to your sensuality and passions? (SC)
Do you feel confident and in control of your life? (SP)
Do you give and receive love freely? (HT)
Am I holding onto past emotional pain? (HT)
Do you feel compassion for yourself and others? (HT)
Do you express yourself clearly and honestly? (TH)
Do you feel heard and understood? (TH)
Do you communicate your truth with confidence? (TH)
Do you trust your intuition? (TE)
Am I open to new perspectives and deeper wisdom? (TE)
Multiple Do I feel connected to something greater than myself? (CW)
Am I experiencing a sense of purpose and spiritual alignment? (CW)
Do I make time for meditation and mindfulness? (CW)