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Kate Klonaris
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Stress Support Sessions
Group Meditation Classes
Private Meditation Sessions
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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
*
Emergency contact
*
Name and phone number
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
Time Management
Committments
Anxiety/Overwhelm
You wish you had more of this in your life:
*
Select up to 5
Energy
Money
Health
Calm
Sleep
Self-Care
Time
Exercise / Movement
Family Time
Romance
Time with friends
Creativity
Support
Happiness
On a scale of 1-10, 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 calm and relaxed you feel on a weekly basis:
*
1 = never calm, 10 = Zen
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2
3
4
5
6
7
8
9
10
On a scale of 1-10, how balanced does your life currently feel?
*
1 = not at all, 10 = perfectly balanced
1
2
3
4
5
6
7
8
9
10
On a scale of 1-10, how happy are you?
*
1 = miserable, 10 = I'm basically glowing with happiness 24/7
1
2
3
4
5
6
7
8
9
10
You feel stressed or anxious:
*
All the time
Regularly
Sometimes
Very occasionally
Never
What is the motivation/reason that brought you to work with Kate now?
*
Have you done any meditation before?
*
No
Yes
Yes, but only when part of a yoga class
If YES, please provide details:
How long ago? Duration? How often? Style of meditation? Do you use apps? Have you been taught before? Why did you stop? What did you like/not like? ETC.
Why do you want to learn to meditate?
*
Do you have any health conditions that require medications and/or supplements?
*
Thankyou! I’m really looking forward to working with you soon.
Kate xo
