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Practitioner Self-Reflection Form

Client Information

Practitioner Information

Session

We appreciate answers to this form in English.

Invocation

Conversation

Activation

Integration

Self-Reflection

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
Also please note - if you have a session specific question you’d like answered, please email us directly via [email protected] as comments in this form may not always be seen due to the high volume received.

Please Read Before You Submit the Form

  • If any required fields are missing, the form will automatically scroll back up to the missing section – but it may not show a red or text error message. Please check carefully for any questions you may have missed, especially ones with a star (*) next to them.
  • You will know your form has been submitted when a confirmation message (see screenshot below) appears saying:
    • “Thank you for submitting this form. Your information has been received and your Practitioner will follow up with you directly, if necessary.”
  • If you do not see this message, your form was not submitted. Please check that all sections are complete and try again.


If you need help submitting the form, please email us at: [email protected]

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