Bio-Energy Healing Post Treatment evaluation Name First Name Last Name Date MM DD YYYY Please select the number that best indicates the average level you are experiencing PAIN 0 = painfree, 10 = worst possible 0 1 2 3 4 5 6 7 8 9 10 STRESS/ANXIETY 0 = none , 10 = worst imaginable 0 1 2 3 4 5 6 7 8 9 10 DEPRESSION 0 = none, 10 = extreme hopelessness 0 1 2 3 4 5 6 7 8 9 10 ENERGY LEVEL 0 = very energetic, 10 = very low energy 0 1 2 3 4 5 6 7 8 9 10 SLEEPING 0 = great sleeping, 10 = not sleeping at all 0 1 2 3 4 5 6 7 8 9 10 Thank you!
