| Practitioners
Name
Date
mm/dd/yy |
| Clients Name
Session # |
| Email
|
| 1. List the essences that
were given, the recommended dosage, and how they were to
be administered. |
|
|
|
|
| 3. Summarize the condition
and goals of the client prior to taking this cycle of
essences. |
|
|
| 4. Describe any changes
that you observed in the client as a result of taking
this cycle of essences. Please list each essence and is
correlation to the observed changes. |
|
|
| 5. Other comments |
|
|
| 6. List the essences that
were given for the next dosage cycle. |
|
|
All information submitted
will be used solely for research purposes and will be
handled with strict confidentiality. |
|
|
