Inese Questionnaire

Name *

First

Last

Email *

Where did you find the link to book the call? Where have you heard about Back 2 Balance Academy? *

What is your biggest challenge right now? Describe in details *

How long have you had this challenge? *

What have you done so far to overcome this challenge? Describe in detail. *

Have you been officially diagnosed with endometriosis? What stage? Have your problems been addressed by medical professionals? Have you had surgery? *

How committed are you on a scale of 0-10 to show up, take full responsibility and move past this challenge?

Selected Value: 0

Is there somebody else besides you who is the decision maker when it comes to your health? *

• Yes
• No

Rate every area from 1-10 (1 - not satisfied at all , 10 - completely satisfied- write the letter and the number next to it Example: MC-9: Health (H); Eating habits (E); Weight (W), Physical Fitness (PF), Stress Level (SL), Menstrual cycle (MC), Relations *

Submit