ideal client survey

Mayumi's Client Questionnaire

* Indicates required field

Why did you first come to see Mayumi? *

Relaxation Injury Chronic Pain

If Other please specify: *

Please Comment on the Following Elements of Care: 1. EVALUATION & First meeting 2. Hands on Work 3. ReEvaluation. 4. Off the Table Education *

Please Choose 3 of the following Descriptive words (Or create your own) that best describes Mayumi work. *

Safe Honouring Effective Unique Release Balancing Personal Integration Relaxation My own Words:

My own words *

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