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Practitioner Self-Reflection Form Self Paced

Client Information

Practitioner Information


We appreciate answers to this form in English.






Please rate your competency in the following areas of your session, and write any comments to yourself for continual improvement:

No preparation
Very well prepared
Didn’t set up sacred space
Sacred space was set up beautifully

Wasn’t able to listen well

Demonstrated active listening and affirming
Didn’t feel clear with verbal guidance
I felt very clear with the content and verbal guidance I gave
Didn’t feel like I chose the right protocols
The protocols I chose were very well matched for the client’s experience
Not well received by the client
Client responded very effectively to the bodywork protocols
My head got in the way and I felt disconnected to my intuition
I felt very connected and trusting of my intuition
I didn’t feel clear or effective in offering new beliefs to my client
The client responded positively to the new beliefs I offered
The client was not responsive to the integration process e.g. was not able relax
The client demonstrated strong signs of being in a deep rest and digest state
I did not offer homework to the client
I gave clear and relevant homework to the client who was positive to implement in their life.
Very low
Very self confident

“Thank you for submitting this form. Your information has been received and your Practitioner will follow up with you directly, if necessary.”