Abstract art of a human face and a burd facing each other

Program follow up

General Information

Full Name

Thanks for submitting!

Gender

Female

Male

Other

Age

Program duration (days)

Intake preferred time

morning

afternoon

evening

No benefit

Great benefit

Do you feel less stressed?

Do you have any addiction? (substance or behaviour)

YES

Please, specify

Well - Being

Connection and Perception

Do I have more contact with my emotions and more clarity about them?No benefitNo benefitNo benefitGreat benefitGreat benefitDo I have more contact with my emotions and more clarity about them?

If the answer is YES, has the treatment helped me in some way to treat it?No benefitNo benefitNo benefitGreat benefitGreat benefitIf the answer is YES, has the treatment helped me in some way to treat it?

No benefit

Great benefit

If the answer is YES, has the treatment helped me in some way to treat it?

Do you notice an improvement in my self observation capacity?No benefitNo benefitNo benefitGreat benefitGreat benefitDo you notice an improvement in my self observation capacity?

Do you feel more capable to experience acceptance and joy?No benefitNo benefitNo benefitGreat benefitGreat benefitDo you feel more capable to experience acceptance and joy?

Do you observe a better performance in my daily activities?No benefitNo benefitNo benefitGreat benefitGreat benefitDo you observe a better performance in my daily activities?

Have my attention and focus improved during the program?No benefitNo benefitNo benefitGreat benefitGreat benefitHave my attention and focus improved during the program?

Did you experience an improvement in the quality of my sexual energy/libido?No benefitNo benefitNo benefitGreat benefitGreat benefitDid you experience an improvement in the quality of my sexual energy/libido?

Did you experience improvement in my sleep/rest quality?No benefitNo benefitNo benefitGreat benefitGreat benefitDid you experience improvement in my sleep/rest quality?

Did you notice an improvement in the quality or intimacy of my personal relationships?No benefitNo benefitNo benefitGreat benefitGreat benefitDid you notice an improvement in the quality or intimacy of my personal relationships?

Did you experience a better sense of unity and interconnectedness with the whole?No benefitNo benefitNo benefitGreat benefitGreat benefitDid you experience a better sense of unity and interconnectedness with the whole?

Did you feel more connected to my sense of meaning and purpose in life?No benefitNo benefitNo benefitGreat benefitGreat benefitDid you feel more connected to my sense of meaning and purpose in life?

Did you notice changes in my sensory or body perception?

YES

Please, specify

Did you notice changes in my time perception?

YES

Please, specify

If you have any meditation practice, did you notice any qualitative change or improvement during the program?

YES

Satisfaction

Did you use our therapeutic support as part of your treatment?

YES

What was your initial motivation to follow the program?

How did the therapy enriched (or not) your process?

Aditional comments ( please feel free to expand in detail, as your process feedback is very valuable for us) Include suggestions if you have them

Did it help me to overcome depression?

No benefit

Great benefit

Did it helped me to feel less anxiety?

No benefit

Great benefit

Do you have more contact with my emotions and more clarity about them?

No benefit

Great benefit

Do you notice an improvement in my self observation capacity?

No benefit

Great benefit

Do you feel more capable to experience acceptance and joy?

No benefit

Great benefit

Do you feel more connected to my creativity?

No benefit

Great benefit

Do you observe a better performance in my daily activities?

No benefit

Great benefit

Have my attention and focus improved during the program?

No benefit

Great benefit

Do you feel more energized?

No benefit

Great benefit

Did you experience an improvement in the quality of my sexual energy/libido?

No benefit

Great benefit

Did you experience improvement in my sleep/rest quality?

No benefit

Great benefit

Did you feel more empathic?

No benefit

Great benefit

Did you notice an improvement in the quality or intimacy of my personal relationships?

No benefit

Great benefit

Did you experience a better sense of unity and interconnectedness with the whole?

No benefit

Great benefit

Did you feel more connected to my sense of meaning and purpose in life?

No benefit

Great benefit

How satisfied are you with the program?

No benefit

Great benefit

Do you want to give us feedback or suggestion?

How easy is it to be flexible and change course?Very DifficultVery DifficultModerate Very easyVery easyHow easy is it to be flexible and change course?

How controlling do you need to be to feel safe?Very controllingVery controllingModerate Very TrustingVery TrustingHow controlling do you need to be to feel safe?

How connected do you feel to nature / your environment?Disconnected Disconnected Moderate Very ConnectedVery ConnectedHow connected do you feel to nature / your environment?

What type of physical exercise or energy work (yoga, gi gong, etc) do you practice?

Frequency per week?

Do you practice meditation or follow any spiritual practice?

Frequency per week?

None

Infinite

How much possibility does life have to offer?

Limited

Trapped

Very free

How much freedom do you generally feel?

Moderate

Very Difficult

Very easy

How easy is it to be flexible and change course?

Moderate

Very controlling

Very Trusting

How controlling do you need to be to feel safe?

Moderate

Disconnected

Very Connected

How connected do you feel to nature / your environment?

Moderate

Trapped

Very free

How much freedom do you generally feel?

Moderate

None

Infinite

How much possibility does life have to offer?

Limited

How easy is it to be flexible and change course?Very DifficultVery DifficultModerate Very easyVery easyHow easy is it to be flexible and change course?

Very Difficult

Very easy

How easy is it to be flexible and change course?

Moderate

How controlling do you need to be to feel safe?Very controllingVery controllingModerate Very TrustingVery TrustingHow controlling do you need to be to feel safe?

Very controlling

Very Trusting

How controlling do you need to be to feel safe?

Moderate

How connected do you feel to nature / your environment?Disconnected Disconnected Moderate Very ConnectedVery ConnectedHow connected do you feel to nature / your environment?

Disconnected

Very Connected

How connected do you feel to nature / your environment?

Moderate