PRIVATE CLIENT Confidential Questionnaire

Ancient practices such as Qigong, Yoga and Meditation were traditionally taught one-on-one with masters passing down their wisdom to their students in a meaningful way as it applied to the individual.

Personalised attention enables you to experience guidance and support in a way that isn't always possible in a group class setting. 

Private sessions can support you on a journey of self inquiry, help you release blocks and barriers, address chronic illness, rewire unhelpful habits and assist you in implementing tailored self-care practices that are unique to your own needs and that fit within your daily routine.

The confidential questionnaire below will help us both prepare for your first and is also a great opportunity for you to practice honest self enquiry.

 

** Close your eyes, take three big breaths into your belly (through the nose and signing out through the mouth), feel into your body and answer the questions below from the space within your belly and heart (rather than from how the 'thinking mind' believes you 'should' answer). 
 

(Any information given in the questionnaire will be confidential, you are not obliged to fill in all the details. However from my experience working with clients, the more honest information shared from the get-go the quicker you will experience positive change). Please don't navigate away from the online form while filling in or the form will clear.

 

 
Name *
Name
Would you like your email address added to our mailing list to receive our newsletter and free things from time to time?
We respect your privacy
Where would you like your first session to take place? *
Please note: In-person sessions are only available for clients by prior agreement. If you intend to have your first session at your home or place of work, please include that address below. If you require room hire, please note there is an additional studio fee and is dependent on availability. If we are meeting over Skype, please include your Skype ID below. If you require other arrangements, please select 'other' and email details of your requirements to leonie@leoniebeck.com
Address
Address
Date of birth
Date of birth
Just a reminder, if there is no ' * ' the question is optional, like this one :)
What attracts you to Qigong and Energy Work? *
You can check more than one
Have you practiced Qigong, Yoga or Meditation before? *
For example, tired and lacking energy, good in the morning but lethargic after lunch, enthused and energised, stiff and tense all over, weak etc.
For example, calm, centred and peaceful, angry, anxious and fearful, overwhelmed, happy etc.
Please check all the words below that you would regularly use to describe yourself
Please check all the words below that you would definitely NOT use to describe yourself
Do you have any pain or injuries in the following areas?
Do you suffer from any of the following?
Dieting restrictively (especially with the intention of changing body shape) is incredibly damaging and has a large impact on self-esteem, health and our Energy on all levels.
Females - Are you pregnant? Please let me know if you become pregnant.
I prefer NOT to be touched on my ....
SAFETY FIRST... Work within YOUR OWN ability and according to your own body wisdom and intuition – we are all different, run your own race, this is the art of personal mastery (rather than comparison and competition). You should not experience any acute physical pain, especially in the knee or lower back region – it’s a signal to ease off. Let me know if you have any new injuries, concerns or conditions, or if you become pregnant. Never strain or force yourself (body, mind or breath). Ease back to your own physical and emotional comfort range. If you are unsure of anything, just ask me. Finally, trust yourself, listen to your body and ENJOY! *
Terms and Conditions *
Find the T&C's here http://www.leoniebeck.com/terms-conditions