Month Check-In Survey for Healing Circle Members
Full Name
Email
Physical Health:
On a scale of 1 to 10, where 1 is no pain or physical issues and 10 is the worst imaginable, how would you rate your current physical well-being now, after 3 months in the healing circle?
Are you experiencing any physical pain or discomfort? If yes, please describe.
How would you describe the quality of your sleep?
Emotional Well-Being:
On a scale of 1 to 10, where 1 is feeling completely calm and emotionally balanced and 10 is the worst distress or imbalance, how would you rate your current mental/emotional well-being now?
Are you experiencing any anxiety or mood challenges? If yes, please describe.
How would you describe your overall emotional state?
Mental Clarity:
On a scale of 1 to 10, where 1 means extremely unfocused and unproductive, and 10 means highly focused and productive, how would you rate your current ability to focus and stay productive?
Are there any mental challenges (e.g., brain fog, lack of motivation) you’re currently facing? If yes, please describe.
How would you describe your overall mental state?
Spiritual Growth:
On a scale of 1 to 10, where 1 is feeling fully connected and at peace spiritually and 10 is feeling completely disconnected or lost, how would you rate your current spiritual well-being now?
Are there any spiritual challenges or questions you’re currently exploring? If yes, please describe.
How would you describe your overall spiritual state?
Reflection:
In your own words, how would you describe where you are right now in your life? What areas do you feel need the most attention or improvement?
Progress Assessment:
On a scale of 1 to 10, where 1 represents no improvement and 10 represents a significant transformation, how would you rate your overall progress since joining the membership?
On a scale of 1 to 10, where 1 means not enjoyable at all and 10 means extremely enjoyable, how would you rate your experience with the membership topics?
Were there any topics that particularly resonated with you? If yes, please describe.
Are there any topics you’d like to see covered in the future?
Would you like to share a personal story or testimonial about your experience with the membership? If yes, please describe.
Additional Questions
Compared to when you started, how much progress do you feel you’ve made in the challenge(s) you were facing (physical, mental/emotional, or spiritual)?
What has been the most valuable part of your experience in the healing circle so far?
What type of support or resource would you like to see added or improved to better meet your needs moving forward (e.g., more guided meditations, deeper discussions, etc.)?
Is there anything else you’d like to share about your experience or current needs as a member?