Souljourner
Healing Arts
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Initial Session Client Intake
Birthdate (MM/DD/YYYY)
What level of pain are you currently experiencing?
0 (no pain)
1
2
3
4
5
6
7
8
9
10 (excruciating pain)
Varies/Unsure
What is the largest planet in our Solar System?
Mercury
Mars
Jupiter
How many continents are there?
5
6
7
Who was the first man to go into space?
Neil Armstrong
Yuri Gagarin
Buzz Aldrin
Where is Budapest?
Hungary
Spain
Portugal
Which of these is a prime number?
1
17
21
4
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