The document contains a questionnaire for patients of Romford & Ilford Family Chiropractic Ltd, located in Romford, Essex. The questionnaire asks patients questions about stress levels and where they hold stress in their body, emotional traumas, sleep habits, happiness levels, financial stressors, and beliefs about health, illness, and the body's ability to heal itself. The purpose is to understand sources of stress and beliefs that may be impacting a patient's health and ability to heal.

1. Romford & Ilford Family Chiropractic LtdTel: 020 8252 1010
313 High Road, Chadwell Heath
Romford, Essex RM6 6AX
www.chiropracticcare.co.uk
 WHERE IN YOUR BODY DO YOU HOLD OR CARRY YOUR STRESS?
 WHAT TOOLS HAVE YOU USED TO TRY TO REDUCE YOUR STRESS?
 WHY DO YOU THINK YOUR BODY FAILED TO HEAL ITSELF THIS TIME?
 DO YOU KNOW WHY YOUR BRAIN AND NERVOUS SYSTEM ARE
KNOWN AS THE MASTER CONTROL SYSTEM?
 TELL ME ABOUT THE 3 MOST SIGNIFICANT EMOTIONAL TRAUMAS IN
YOUR LIFE.
 HOW MANY HOURS DO YOU SLEEP ON AN AVERAGE EVENING?
 HOW WOULD YOU RATE YOUR LEVEL OF HAPPINESS ON A SCALE OF
1 – 10 WITH 10 BEING HIGHEST?
 IS MONEY A STRESS IN YOUR LIFE?
 WHAT IS CURRENTLY MISSING FROM YOUR LIFE?
Questionnaire:

2. Romford & Ilford Family Chiropractic LtdTel: 020 8252 1010
313 High Road, Chadwell Heath
Romford, Essex RM6 6AX
www.chiropracticcare.co.uk
 WHAT DO YOU THINK MIGHT LIE AT THE ROOT OF YOUR ILLNESS?
 WHAT ARE YOUR BELIEFS ABOUT HEALTH?
 WHAT ARE YOUR BELIEFS ABOUT ILLNESS?
 WHAT ARE YOUR BELIEFS ABOUT THE BODY BEING ABLE TO HEAL AND
REPAIR ITSELF?
 WHAT IS THE MAIN FOCUS TODAY?