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Kate Klonaris
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Stress Support Sessions
Group Meditation Classes
Private Meditation Sessions
Cart
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Home
About
Kate Klonaris
Services
Stress Support Sessions
Group Meditation Classes
Private Meditation Sessions
Testimonials
Contact
New Client Information
Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Mobile Phone
*
Email Address
*
Date Of Birth
*
Occupation
*
How did you find out about Project Soul?
*
The 3 main stressors in your life are:
*
Select 3
Work
Health problems
Balance
Family
Relationship
Sleep
Finances
Food shopping
Food preparation
Time Management
Committments
Weight Management
You wish you had more of this in your life:
*
Select 3
Energy
Money
Health
Sleep
Self-Care
Healthy food
Exercise / Movement
Family Time
Romance
Time with friends
Creativity
Calm
Support
On a scale of 1-10, this is how "well / healthy / energetic" you feel on a weekly basis:
*
1 = not well at all, 10 = I feel amazing all the time
1
2
3
4
5
6
7
8
9
10
On a scale of 1-10, how balanced does your life currently feel?
*
1
2
3
4
5
6
7
8
9
10
You feel stressed or anxious:
*
All the time
Regularly
Sometimes
Very occasionally
Never
Have you done mediation or relaxation breathing before?
*
Yes
No
No, but I'd like to start
If YES, please provide details:
Do you have any health conditions that require medications and/or supplements?
*
Is there a particular goal or area of stress you would like to wok on during our time together?
*
You you like to be kept in the Project Soul loop and receive the monthly newsletter?
*
Yes please
No thanks
Thankyou! I’m really looking forward to working with you soon.
Kate xo
