Have you had any diseases, injuries or surgeries? 
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
          
                Diagnosed with a psychological condition? Do you have anxiety/depression? Are you on medication?
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
          
                Do you have any spiritual practices? Do you meditate? How connected do you feel to Spirit?
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
          
                On a scale of 1-10 how connected to Spirit are you? (1 being least and 10 being most)