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Mind Self-Reflection 11-14
11. Yes & No Self-Reflection
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Liver Burden Assessment
Liver Burden Calculator
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Liver Burden Calculator
Are you having trouble with weight gain, hypertension, high cholesterol, blood sugar regulation, fatigue, brain fog, mood swings, anxiety, depression, pain, digestive,
menopause,
sleep or skin problems or any other mystery health issue? Chances are it’s because your liver is overburdened and unable to handle its responsibilities.
Let’s take a look at what might be stressing out your liver. This is an extensive questionnaire based off of
Liver Rescue by Medical Medium
that takes into consideration many of the various ways your liver can be overwhelmed thus making it difficult for you to lose weight.
If you are human, leave this field blank.
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Book an Integrative Guided Healing Session
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Step 2: Intake Form
Intake Form - Integrative Guided Healing Session
Have you ever had a Resonate Health Integrative Guided Healing Ceremony or any other healing session before somewhere else? If yes, please describe.
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What is your intention for this healing ceremony? Are there any specific themes that you feel called to explore more deeply? Please share any specific area of your life, priority, topic or focus point that you wish to address during this session.
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Please provide any health information you would like to share that may be pertinent to this session. If you are a member please ensure your Health Profile is updated.
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Book a 60 min Nutritional Consulting Session
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Step 2: Intake Form
Intake Form - 60 Minute Nutritional Consulting
What are your goals for today's session?
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Describe what you typically eat for each meal (or if you skip) including snacks. Indicate what time you usually eat your meals and snacks.
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How much of the following do you consume per day on average? -Water -Caffeinated Beverages -Alcoholic Beverages -Soda -List anything else you typically drink & how much
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Do you abide by any of the following special diets?
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Gluten-free
Grain-free
Dairy-free
Vegan
Vegetarian
Paleo
Keto
Low-carb
No special diet
List your current supplements and medications including the dosage.
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Do you tend to make food choices that you know are not in your best interest but have difficulty controlling yourself? Please explain.
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Do you have any significant dental history such as (check all that you have or have had in the past)
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Orthodontia
Malocclusion
Missing teeth or extractions
TMJ
Clenching or grinding
Use an oral appliance such as mouth guard
Sleep Apnea
Tongue Tie
Other
Other
None of the above
My Health Profile information is up to date in my Resonate Health portal.
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Yes
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Book a 60 min Integrative Consulting Session
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Step 2: Intake Form
Intake Form - 60 min Integrative Consulting
Please share your goals for this call, questions and anything that will help prepare for our meeting. If you're a member please update your Health Profile.
We want to ensure all your questions have been answered during this call.
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Request a Personalized Supplement Protocol
Intake Form - Personalized Supplement Program
I want this supplement protocol to be:
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A complete new protocol
An update of my current protocol
A protocol to support a specific issue
I set the intention that this personalized supplement protocol most optimally supports me in this area of my life...(select one)
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For my overall highest and greatest good
Physical pain or injury
Emotional hardship
Life transition/change
Unsure or need help in many areas
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Other
Add any other details you want us to know before we make your Personalized Supplement Protocol.
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Request a Personalized Program
Intake Form - Personalized Program
I want my personalized program to focus on: (Other can include a card pulling, if desired please name the deck.)
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Only Master Guide Items (no supplements)
A mix of whatever I need to optimally support me
Other
Other
I set the intention that this personalized program most optimally supports me in this area of my life...(select one)
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For my overall highest and greatest good
Physical pain or injury
Emotional hardship
Life transition/change
Unsure or need help in many areas
Other
Other
Add any other details you want us to know before we make your Personalized Program.
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Request a Personalized Biofield Tuning Recording
Intake Form - Personalized Biofield Tuning Recording
Please indicate your desired topic and be as specific as possible. I intend for this tuning to focus on:
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Book a 20 min Integrative Consulting Session
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Step 2: Intake Form
Intake Form - 20 min Integrative Consulting
Please share your goals for this call, questions and anything that will help prepare for our meeting!
In a short call we want to ensure you feel complete and that all your questions have been answered.
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Book a Live Biofield Tuning
Step 1: Pick a Date & Time
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Step 2: Intake Form
Intake Form - 60 min Live Biofield Tuning Session
What's your main goal?
The session's main intention is to provide optimal alignment and resonance to your Biofield. Please share any other specific intention, priority, topic or area of focus that you would like to add to the theme of this session.
Check any that apply:
Currently Pregnant
Trying to get Pregnant
Active Cancer
Cardiac Pacemaker
Other Heart Conditions
Terminal Illness
Obesity
Recent broken bones
Concussion or Head Injury < 3 months ago
Epilepsy
Had nervous breakdown or psychotic episode < 1 year ago
Any checked will require brief review at the start of your session.
Please provide any other health information you would like to share.
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