5 Element Acupuncture for Busy Practitioners Intake Self-Assessment

Please fill out this assessment in order to understand how you feel about your practice and the 5 elements before you start the program. You’ll fill out a similar survey at the end of the program so you can compare and see what’s shifted for you!

Please enter the email address that you used when registering for this program:(Required)

What was going on in your life or practice that prompted you to want to add the 5 elements to your practice?(Required)

How familiar are you with the 5 elements currently?(Required)

What are you hoping to achieve through this program?(Required)

What are you the most curious to learn about the 5 elements?(Required)

Please rate each of the following on a scale of 1 to 10 about your current practice.

My practice is emotionally sustainable. I’m not feeling burned out by my patients and workload and I feel fulfilled and satisfied.(Required)

My interactions with my patients are meaningful and I feel able to help them with more than physical issues and symptom management.(Required)

I’m able to develop a heartfelt and genuine therapeutic relationship with my patients.(Required)

I’m satisfied with my patient outcomes, or how quickly and deeply people are able to heal when receiving my care.(Required)

I understand how to find and treat root cause issues for my patients.(Required)

I feel confident treating emotional and spirit based issues and supporting my patients through that process.(Required)

I feel like I have a unique skill set and point of view for my practice and that sets me apart from other acupuncturists.(Required)

Anything else you’d like to note about your practice struggles or goals?(Required)

5 Element Acupuncture for Busy Practitioners Intake Self-Assessment

Please rate each of the following on a scale of 1 to 10 about your current practice.

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