Sophrology Questionnaire

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Sophrology Questionnaire

Sophrology online workshops

* Indicates required field

This questionnaire will help the Sophrologist develop a series of Sophrology workshops appropriate to the clients’ needs. The workshop is delivered over eight weeks, with each session lasting 1 hour.

We will treat all information provided in the strictest confidence, and all details will remain private.

Name *

First

Last

Email *

What is your age? *

Up to 21 22 – 35 36 – 45 46 – 55 Over 55 (please state)

Age if over 55: *

Reasons for wanting to attend the workshop *

Stress Sleep problems Anxiety Depression Managing emotions Self-development General interest Other (please state)

Other reasons: *

What methods do you currently use to help you with the above? *

Have you ever practised any organised relaxation, meditation, or self-development class before? *

Yes No

Do you have any difficulties with breathing exercises or visualisations? *

Yes No

Do you suffer from pain or limited movements in any joints? *

Yes No

Are you pregnant? *

Yes No

Describe in a few sentences how stress affects you: *

What would you most like to get from the workshop? *

Please answer the following questions below using a scale of 1 to 10, where 1 is extremely low/poor/negative and 10 is extremely high/good/positive. For each, try to write one sentence, phrase or word that best describes the rating you have chosen.

Overall health and well-being? *

My overall health and well-being: *

Everyday energy levels? *

My everyday energy levels: *

Quality of sleep? *

My quality of sleep: *

Level of stress/anxiety? *

My level of stress/anxiety: *

Level of self-confidence? *

My level of self-confidence: *

Level of concentration? *

My level of concentration: *

Ability to relax? *

My ability to relax: *

When is the most convenient time for you to attend the workshop? (select all that apply) *

Weekday lunchtimes Weekday evenings Saturday morning Saturday afternoon Saturday evening Sunday morning Sunday afternoon Sunday evening Other (please specify)

Other specific times: *

Any other comments: *

Date questionnaire completed: *