Self Analysis

Pre Consultation Self  Analysis

Immediate Concerns

For me to be able to fully address your needs to your satisfaction I need to know how YOU feel.about your state of health and wellbeing so please fill in the following questionaire as part of your preparation for our consultation and bring it with you.

In terms of you health and wellness, what are your IMMEDIATE pains, frustrations and concerns.Think of how you FEEL and PERFORM in your daily life.

Future Concerns

What are your fears and concerns about your FUTURE health and wellness as you age?

Immediate Goals and Desires

Relative to your pains and frustrations what are your immediate goals and desires.

Think of how you would like to feel and perform in your daily life

Future Dreams and Aspirations

Relative to you concerns for your future health and wellness what are your dream and aspirations?


Recurrent or persistent back pain, neck pain, headache or other painPersistent sub-optimal health (never feeling entirely well)Poor sleeping patterns (insomnia, broken sleep, not feeling rested in the mornings etc.)Tiredness/lethargicPoor concentration/short attention spanpersistent feeling of tension/stress (inability to relax)Poor affect/moodA sense of not quite achieving a suitable level of performance every day


DisabilityImmobilityAccelerated agingEscalating painDejection/depressionChronic/frequent illnessesChronic/frequent conditionsSurgeryDrug therapy dependenceDrug therapy side effectsDeclining quality of lifeIncreasing dependence on othersDeclining performance/achievement of personal goals


Pain freeBetter health and a feeling of well beingVitality/zest for lifeCalmness/tranquility (ability to relax)A sense of achievement and a desire to raise performance levels ever higherSharp, sustained focus


Abundant health and wellnessAbundant vitality/energyFull mobility and abilityHigh level performanceAchievement of day to day and long term goalsMaximum quality of lifeSlower rate of agingAging without serious pains, conditions and illnessesMaintaining independenceDrug freeSurgery free