Our Local Friends – Practitioners & Other Professionals
Massage Therapist – Kerry Fernandez at Kerry Massage & Healing Space Call 201.681.5626
Make Up Artist – Dawn Maloney Call 973-494-2515
Master Hair Stylist – Lori Damiano at Melandre Salon Call 973-667-3100
Master Hair Colorist – Raymond Serio also at Melandre Salon
Chiropractor – Dr. Charles Marinelli Call 973-777-2822
Metaphysical Store – Mystical World Call 201-896-3999
Guidance Meditation/Prayer to start the day:
Watch this introductory video:
For more information regarding BEMER, contact me on 714.421.8489.
Please copy this questionnaire and paste it into a “Word” document, complete and send back as an attachment to email@example.com. If this is not possible for some reason, please email me and we will consider an alternative method to the above-mentioned instructions. Thank you!
Note: All materials you receive as part of this coaching program are copyrighted by Carol Lynne Fouad/Core Healing Essentials and are not to be distributed to other individuals. Thank you for your integrity!
- On a scale of 1 to 10 (1 being low, 10 being high) please indicate your level of concern regarding the health of the following: (Please feel free to provide those concerns)
Bones (Including joints and spine):
Soft Tissue (Muscles, tendons, ligaments, fascia):
Endocrine System (Hormones):
Respiratory System (Including Sinuses):
- If any, what steps have you previously taken to find solutions to the above?
- Did you obtain results with the products or methods used to rebalance?
- Are you currently taking medication or have you in the recent past?
For which condition(s)?
- How many ounces of the following beverages do you typically consume in a day?
Water: Coffee: Tea (with caffeine): Tea (without caffeine) Soda (with caffeine & sugar): Soda (without caffeine and sugar): Alcohol: Fruit Juice:
- How much of the following foods are in your regular diet? (Please indicate Low, Medium or High)
Good fats (avocado, butter from grass-fed cows, olive oil, nuts, coconut oil, etc):
Other fats (margarine, animal fats, GMO oils, chips, fried foods, etc.):
Complex Carbs (oatmeal, beans, lentils, peas, etc): Refined Sugar (candy, cakes, other sugary desserts:
Meat-based proteins: Plant-based proteins:
- Do you take supplements? If so, please list:
- Do you regularly experience physical discomfort? If yes, please explain:
- Of the following basic emotions, which is the dominant one that you regularly experience and to what degree? . (Please indicate Low, Med, High, Extremely High)
Anger: Sadness: Guilt: Fear:
- Which statement is mostly true?
My mind is usually calm My mind is seldom calm My mind is never calm
- Are you in tune with your intuition or inner knowing?
- Are you aware of any numbers or groups of numbers that often present in the form of: time on a clock, license plates, totals on a receipt, etc? (May sound like an odd question, but please indulge me!)
- Have you ever used Aromatherapy therapeutically – either by inhalation or topical use?
- Have you recently or in the past lost someone close to you that has had a major impact on your state of well-being?
- Do you remember your dreams? If so, are there any reoccurring or have any been upsetting recently?
- Do you meditate? If so, do you do so on a regular basis?
- Thinking with your heart, rather than your logic, what type of results you are seeking by participating in an Empowerment Coaching program?