PRACTICE TREATMENT FORM Energy Reading Course Please enable JavaScript in your browser to complete this form.Student Name *FirstLastEmail Address *Setting where conducted (Zoom, Online, Face to Face etc.) *Client Name *Client Age *Client GenderMaleFemaleNon-BinaryOccupationMarital StatusReason for sessionSession Date *Session Number (This Client)Time of Session * Energy Reading Practise Session Has confidentiality agreement been confirmed with client before you begin?YesNoPhotographs taken: before session and after session:YesNoPRACTICE SESSION ENERGY READING VISUALS Aura and Chakra Reading Drawings Click on the image to download a copy: Upload your drawing here: Click or drag files to this area to upload. You can upload up to 3 files. PRACTISE SESSION ENERGY READING NOTES: Only complete what is relevant to the session Light entering down central channel. Brief Notes:Aura, Brief Notes:First LayerSecond LayerThird LayerFourth LayerFifth LayerSixth LayerOuter LayersChakras. Brief Notes:BaseSecondSolar PlexusHeartThroatThird EyeCrownMeridians, Brief Notes--------------------------------------------------------------------------------------------------------------------------------------------------------LUNGLeft LungFlowingFlowingFlowing slowHalf BlockedBlockedRight LungFlowingFlowingFlowing slowHalf BlockedBlockedLARGE INTESTINELeft Large IntestineFlowingFlowingFlowing slowHalf BlockedBlockedRight Large IntestineFlowingFlowingFlowing slowHalf BlockedBlockedSTOMACHLeft StomachFlowingFlowingFlowing slowHalf BlockedBlockedRight StomachFlowingFlowingFlowing slowHalf BlockedBlockedSPLEENLeft SpleenFlowingFlowingFlowing slowHalf BlockedBlockedRight SpleenFlowingFlowingFlowing slowHalf BlockedBlockedHEARTLeft HeartFlowingFlowingFlowing slowHalf BlockedBlockedRight HeartFlowingFlowingFlowing slowHalf BlockedBlockedSMALL INTESTINELeft Small IntestineFlowingFlowingFlowing slowHalf BlockedBlockedRight Small IntestineFlowingFlowingFlowing slowHalf BlockedBlockedURINARY BLADDERLeft Urinary BladderFlowingFlowingFlowing slowHalf BlockedBlockedRight Urinary BladderFlowingFlowingFlowing slowHalf BlockedBlockedKIDNEYLeft KidneyFlowingFlowingFlowing slowHalf BlockedBlockedRight KidneyFlowingFlowingFlowing slowHalf BlockedBlockedPERICARDLeft PericardFlowingFlowingFlowing slowHalf BlockedBlockedRight PericardFlowingFlowingFlowing slowHalf BlockedBlockedGALL BLADDERLeft Gall BladderFlowingFlowingFlowing slowHalf BlockedBlockedRight Gall BladderFlowingFlowingFlowing slowHalf BlockedBlockedLIVERLeft LiverFlowingFlowingFlowing slowHalf BlockedBlockedRight LiverFlowingFlowingFlowing slowHalf BlockedBlockedDU MAILeft Du MaiFlowingFlowingFlowing slowHalf BlockedBlockedRight du MaiFlowingFlowingFlowing slowHalf BlockedBlockedREN MAILeft Ren MaiFlowingFlowingFlowing slowHalf BlockedBlockedRight Ren MaiFlowingFlowingFlowing slowHalf BlockedBlockedCHONG MAILeft Chong MaiFlowingFlowingFlowing slowHalf BlockedBlockedRight Chong MaiFlowingFlowingFlowing slowHalf BlockedBlockedSpine & Pelvis (If relevant) Brief NotesEnergy Flowing In:CERVICALTHORACICLUMBARSACRUMCOCCYXPELVIS AREAFOLLOW UP SESSION:If this is a follow up session, ask the client about how they have been doing since the last session for e.g. ‘how has it gone – how are you feeling since last session?’ ‘How was the last session for you?’ ‘How have you been?’ ‘Any changes or points to share’? REFLECTIVE LEARNING NOTESContent of session:SUMMARY of the points in the session (inc. presenting imbalances):Overview of SESSION: what was your process / method? What happened?Next steps for this client:PERSONAL LEARNING FOR YOUConducting the session: What did you do well?What did you find difficult or a challenge? What skills / knowledge do you need to develop? What do you feel about the client and their problem?What did you specifically learn from this practise?What will you change or do differently in your next practise treatment (with another client)?Submit
