Email Address

Specific sleep challenges I have:

PAIN

I experience chronic pain in my body

I know the cause of this pain

My pain is felt & experienced more

FOCUS

I have trouble following through on something without becoming distracted

I look at my phone before I get out of bed

I have a meditation, relaxation, or exercise routine that supports me in clearing my mind

IMMUNITY

I eat _____% of my meals per week from restaurants

I usually eat _____ for breakfast

I consume about ___ servings of fresh fruit and vegetables weekly

RELATIONSHIPS

I feel supported by the people closest to me

I love & respect myself

I express what I need and ask for what I want

CREATIVITY & CREATION

Something I've created that I'll never forget:

What do I do to get out of the box:

I am currently working on ___ project

SPIRITUALITY

I have a practice that connects me to something greater than myself

I feel connected to something greater than myself

I feel supported by something greater than myself

FINANCES

Finances cause me stress

I earn enough or more for my basic needs

I have long term financial goals

HEALTH ASSESSMENT