Client Session Notes Template

PrimeMyChakras Session

INTAKE DATE:

Name:                                                                                      Ph:                                                                                                                    Email:


Areas or Concerns They Wish to Improve

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DATE:

SEVEN CHAKRA SURVEY

1.       Root:  I feel safe, secure and stable without fear blocking me. *Strongly agree *Somewhat *Disagree   

2.      Sacral: I honor my relationships with others past and present without guilt or blame blocking me. *Strongly agree *Somewhat *Disagree

3.      Solar Plexus: I love and honor my relationship with self without shame blocking me.  *Strongly agree *Somewhat *Disagree

4.      Heart: I give and receive love with grace and ease without grief blocking me. *Strongly agree *Somewhat *Disagree

5.      Throat: I express my truth easily and confidently without dishonest blocking me. *Strongly agree *Somewhat *Disagree

6.      Third Eye: I trust my intuitive insights without illusions blocking me. *Strongly agree *Somewhat *Disagree

7.       Crown: I know how to celebrate life and be connected to All That Is without attachments blocking me. *Strongly agree *Somewhat *Disagree

 

ROOT CHAKRA SURVEY

1.      I feel safe, secure and stable. *Strongly agree *Somewhat *Disagree

2.      I have unmet needs from my childhood. *Strongly agree *Somewhat *Disagree

3.      I have a tendency to overdo and/or overthink. *Strongly agree *Somewhat *Disagree

4.      I know how to live in the moment. *Strongly agree *Somewhat *Disagree

5.      I accept change in my life with grace and ease. *Strongly agree *Somewhat *Disagree

6.      Money and abundance comes to me easily. *Strongly agree *Somewhat *Disagree

7.      Most days I feel present in the moment and grounded. *Strongly agree *Somewhat *Disagree

8.      My physical body is healthy and strong. *Strongly agree *Somewhat *Disagree

9.      I feel accepted within my communities or social groups. *Strongly agree *Somewhat *Disagree

10.  I sometimes sabotage my goals and success. *Strongly agree *Somewhat *Disagree

11.  My life is organized and balanced. *Strongly agree *Somewhat *Disagree

12.  I have a healthy relationship to Mother Earth. *Strongly agree *Somewhat *Disagree

13.  Fear closes down our Root Chakra which affects our Right To Be Here. What are you most afraid of? *

 

Session Notes:

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DATE:

SACRAL CHAKRA ASSESSMENT

1.      My personal relationships are healthy. *Strongly agree *Somewhat *Disagree

2.      I manage my feelings and emotions easily. *Strongly agree *Somewhat *Disagree

3.      My life has a purpose. *Strongly agree *Somewhat *Disagree

4.      I live my life with passion and creativity. *Strongly agree *Somewhat *Disagree

5.      I deserve to have pleasure and joy in my life. *Strongly agree *Somewhat *Disagree

6.      I have guilt, frustration or disappointment that interferes with my ability to receive pleasure, intimacy, or abundance. *Strongly agree *Somewhat *Disagree

7.      I understand that money is simply a tool for exchanging energy and I give and receive it easily. *Strongly agree *Somewhat *Disagree

8.      I am open to receive intimacy and pleasure in my life. *Strongly agree *Somewhat *Disagree

9.      I am living an abundant life. *Strongly agree *Somewhat *Disagree

10.  I know and understand how to shift from being a victim and blaming others to being responsible. *Strongly agree *Somewhat *Disagree

11.  I know I have the ability to change my inner critic. *Strongly agree *Somewhat *Disagree

12.  I am able to connect to my higher wisdom within my sacred heart space. *Strongly agree *Somewhat *Disagree

13.  Guilt closes down our Sacral Chakra which affects our Right To Feel. Do you blame yourself for anything? *Strongly agree *Somewhat *Disagree

 

ABUNDANCE SELF ASSESSMENT

1.      I am swimming in oceans of abundance. *Strongly agree *Somewhat *Disagree

2.      When I see things I really want, I tell myself it's wrong to want so much. *Strongly agree *Somewhat *Disagree

3.      I consistently focus on manifesting what I want in my life.  *Strongly agree *Somewhat *Disagree

4.      I'm a good steward of money. I save and invest wisely. *Strongly agree *Somewhat *Disagree

5.      I feel financially secure and I know I'll always be well taken care of in the future. *Strongly agree *Somewhat *Disagree

6.      I worry about money all of the time. *Strongly agree *Somewhat *Disagree

7.      I live in a constant state of gratitude for all I have. *Strongly agree *Somewhat *Disagree

8.      I have an abundance of love and peace in my life. *Strongly agree *Somewhat *Disagree

9.      I create from my heart and manifest naturally. *Strongly agree *Somewhat *Disagree

10.  I am open to receive gifts from the universe. *Strongly agree *Somewhat *Disagree

11.  I am 100 % responsible for what happens in my life around money. *Strongly agree *Somewhat *Disagree

12.  My beliefs create my experiences. *Strongly agree *Somewhat *Disagree

13.  I deserve the highest and best in life and draw the highest and best to me. *Strongly agree *Somewhat *Disagree

14.  I understand how abundance is really a mindset. *Strongly agree *Somewhat *Disagree

15.  I have created a big vision for my life and am willing to invest in myself. *Strongly agree *Somewhat *Disagree

16.  I operate from a scarcity mindset. *Strongly agree *Somewhat *Disagree

 

Session Notes:

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DATE:

SOLAR PLEXUS CHAKRA ASSESSMENT

1.      I am judgmental and critical of myself.  *Strongly agree *Somewhat *Disagree

2.      I nurture my body, mind and spirit in healthy ways. *Strongly agree *Somewhat *Disagree

3.      I take responsibility for my life choices and forgive myself when I need to. *Strongly agree *Somewhat *Disagree

4.      I have a healthy balance between service to others as well as myself. *Strongly agree *Somewhat *Disagree

5.      I fear failure and rejection.  *Strongly agree *Somewhat *Disagree

6.      I love myself unconditionally. *Strongly agree *Somewhat *Disagree

7.      I easily create and attain my intentions and goals for my personal growth.  *Strongly agree *Somewhat *Disagree

8.      I stand strong in my power.  *Strongly agree *Somewhat *Disagree

9.      I trust myself to make the best decisions possible in my life.  *Strongly agree *Somewhat *Disagree

10.  I am grateful for all that I AM and do. *Strongly agree *Somewhat *Disagree

11.  I know how to quiet my mind and just BE. *Strongly agree *Somewhat *Disagree

12.  I have a sense of peace and freedom in my life.  *Strongly agree *Somewhat *Disagree

13.  Shame closes down our Solar Plexus chakra which affects our Right To Act. Do you feel ashamed of anything? *

 

FINANCIAL ABUNDANCE ASSESSMENT

1.      If you had a desired level of financial abundance what would you use it for? *

        a.       Pay off bills and eliminate debt

        b.      Supplement income to enhance lifestyle

        c.       Create wealth and financial freedom

        d.      Be in service to others

2.      List what you would love to do or become if money was not an issue. *

        a.       What are your current options for increasing your monthly cash flow? *

3.      Would you be open to learning about building a Service Oriented Business with PrimeMyBody? *

        a.       Yes

        b.      I’m not sure

        c.       No

 

Session Notes:

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DATE:

HEART CHAKRA ASSESSMENT

1.      I love myself and others unconditionally. *Strongly agree *Somewhat *Disagree

2.      I give and receive love effortlessly. *Strongly agree *Somewhat *Disagree

3.      I am fearful of opening my heart to others. *Strongly agree *Somewhat *Disagree

4.      I freely give my gifts to the world. *Strongly agree *Somewhat *Disagree

5.      I am in alignment with my heart’s desires. *Strongly agree *Somewhat *Disagree

6.      I strengthen the function of my heart and lungs through deep breathing often. *Strongly agree *Somewhat *Disagree

7.      I graciously receive gifts from others. *Strongly agree *Somewhat *Disagree

8.      My heart is open to receive the energy of love. *Strongly agree *Somewhat *Disagree

9.      I express joy with grace and ease. *Strongly agree *Somewhat *Disagree

10.  I easily feel spontaneous gratitude. *Strongly agree *Somewhat *Disagree

11.  I reach out to others for love and support when I am challenged. *Strongly agree *Somewhat *Disagree

12.  I identify and release “world pain” and despair without attachment. *Strongly agree *Somewhat *Disagree

13.  Grief closes down our Heart Chakra which affects our Right To Love And Be Loved. Are you grieving anything? *

 

MIDPOINT EVALUATION ASSESSMENT

1.      How has working with your chakras impacted you? Describe any changes in your physical, emotional, mental, or spiritual bodies. *

2.      How has your understanding of abundance changed after exploring the first 3 lessons? *

3.      Describe how the energy of abundance is shifting in your life as a result of this program. Please share any recent abundance experiences for which you are grateful. *

4.      How are you using the Daily Chakra Activation practices? What do you find useful and why? *

5.      How often are you using the PrimeMyBody hemp oil? *

6.      Please describe your experience with the hemp oil and any changes you are experiencing by using it? *

7.      Have your shared your experiences with the hemp oil with others? *

8.      What are you telling them? If you have not started sharing about PMB Hemp oil, what would you like people to know about it? *

9.      What are your thoughts about becoming a PrimeMyBody affiliate? *

10.  Would you like to continue the PrimeMyChakras process? *

 

Session Notes:

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DATE:

THROAT CHAKRA ASSESSMENT

1.      I speak only the truth. *Strongly agree *Somewhat *Disagree

2.      I know when it is time to speak and time to listen. *Strongly agree *Somewhat *Disagree

3.      I am aligned with my highest truth. *Strongly agree *Somewhat *Disagree

4.      I own my power and speak confidently. *Strongly agree *Somewhat *Disagree

5.      I listen to myself and think before I speak. *Strongly agree *Somewhat *Disagree

6.      I express myself fully and creatively. *Strongly agree *Somewhat *Disagree

7.      I speak my truth with confidence. *Strongly agree *Somewhat *Disagree

8.      I communicate with clarity and ease. **Strongly agree *Somewhat *Disagree

9.      I am aligned with my highest truth. *Strongly agree *Somewhat *Disagree

10.  I am calm and well spoken. *Strongly agree *Somewhat *Disagree

11.  I surrender my personal will to Divine will when I need to. *Strongly agree *Somewhat *Disagree

12.  I follow my own inner direction. *Strongly agree *Somewhat *Disagree

13.  Lies or suppressed secrets blocks our Throat Chakra which affects our right to speak and hear truth. What are you not being honest with yourself about? *

 

GETTING STARTED WITH PMB ASSESSMENT

1.      Sign up to be affiliate with your PMC Coach and complete the following checklist: To get started attain your PMC’s Coaches PrimeMyBody’s website page to sign up for $39. When you sign up, it’s important to record your username and password! The username you select during the enrollment process is also the name of your replicated website: http://www.username.primemybody.com. Your username can be changed at any time in the Account Settings of your Back Office.

        *I HAVE COMPLETED THIS STEP

        *I HAVEN'T COMPLETED THIS STEP

2.      Your Active Status: In order to be considered an Active Affiliate to receive the different levels of compensation, you and/or a customer must purchase on a monthly basis at least $89.00 worth of product that generates volume. This Active requirement can be met two ways: 1. by purchasing product directly from your Back Office - product order, product package order or Auto-Delivery 2. through your replicated website via customer(s) purchasing product(s).

        *I HAVE COMPLETED THIS STEP

        *I HAVEN'T COMPLETED THIS STEP

3.      Connect to the PMB App: The PrimeMyBody mobile app helps you build a strong and successful PMB business! With cutting-edge industry technology, and evolved platform gives you new tools and features to help with prospects and generate new Customers like never before! You will find all of the information on how to sign up on your PMB back office dashboard.

        *I HAVE COMPLETED THIS STEP

        *I HAVEN'T COMPLETED THIS STEP

4.      Plugging In:

        a.       Join Sacred Intentions Green Team Facebook Page

                *I HAVE COMPLETED THIS STEP

                *I HAVEN'T COMPLETED THIS STEP

        b.      Monday Leadership Call: Join our field’s top leaders from around the country as they come together to share their love for PMB and what is working in their         business! Also, hear the newest Affiliate Promotions & announcements, in addition to all of the amazing things happening at PMB! This is a very powerful weekly call         that will give you the foresight and knowledge to build a successful business -- and be sure to have ALL of your team plugging into this weekly call! Every Monday, 8PM         CST • Dial: 712-432-4604 • Pin: 77463

                *I HAVE COMPLETED THIS STEP

                *I HAVEN'T COMPLETED THIS STEP

        c.       Wednesday Zoom Overview Video Call: Our weekly Overview calls are designed for our Affiliate’s guests and prospects! Led by our field’s top leadership, these calls         last approximately 15-20 minutes, and they deliver some incredible information regarding our amazing products & Opportunity. Every Wednesday @ 8:00 CST         https://zoom.us/j/91625877. To join the meeting, select the link.

                *I HAVE COMPLETED THIS STEP

                *I HAVEN'T COMPLETED THIS STEP

        d.      Saturday New Affiliate AND Affiliate Training Calls:

        NEW Affiliate Zoom Overview Training every Saturday at 11:00 am CST.
        https://zoom.us/webinar/register/686d34e2c2f68edd7510d14dfea9e911
        Affiliate Training Call every Saturday at 12:00 pm CST

                *I HAVE COMPLETED THIS STEP

                *I HAVEN'T COMPLETED THIS STEP

        e.       Identify Your Leaders: Maintaining an established line of communication with your coach and/or upline is an essential component for growth within your business.         In your notes, write down your coach's name and number! Be sure to take time to meet and get to know your upline leaders; their experience will help to navigate and         guide you throughout your PMB journey.

                *I HAVE COMPLETED THIS STEP

                *I HAVEN'T COMPLETED THIS STEP

 

Session Notes:

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DATE:

THIRD EYE CHAKRA ASSESSMENT

1.      My spiritual insight is clear. *Strongly agree *Somewhat *Disagree

2.      I am connected to my higher self. *Strongly agree *Somewhat *Disagree

3.      I trust my insights. *Strongly agree *Somewhat *Disagree

4.      My intuition and awareness is a gift. *Strongly agree *Somewhat *Disagree

5.      I know how to connect to my higher power. *Strongly agree *Somewhat *Disagree

6.      I know how to tell the difference between my intuition and my ego. *Strongly agree *Somewhat *Disagree

7.      I am intuitive. *Strongly agree *Somewhat *Disagree

8.      I trust the guidance I receive. *Strongly agree *Somewhat *Disagree

9.      All of the answers I need are inside of me. *Strongly agree *Somewhat *Disagree

10.  I connect daily to Source energy. *Strongly agree *Somewhat *Disagree

11.  I know and understand what my intuitive gifts are. *Strongly agree *Somewhat *Disagree

12.  I am able to receive messages from Spirit. *Strongly agree *Somewhat *Disagree

13.  The illusion of being isolated or separated closes down our Third Eye Chakra which affects our Right To See. What illusion is separating you from your highest potential? *

 

Session Notes:

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DATE:

CROWN CHAKRA ASSESSMENT

1.      My spiritual insight is clear. *Strongly agree *Somewhat *Disagree

2.      I am connected to my higher self. *Strongly agree *Somewhat *Disagree

3.      I see Divine light in everyone. *Strongly agree *Somewhat *Disagree

4.      I am unconditionally loved by the Divine. *Strongly agree *Somewhat *Disagree

5.      I am complete. *Strongly agree *Somewhat *Disagree

6.      I am one with All That Is *Strongly agree *Somewhat *Disagree

7.      I am abundant. *Strongly agree *Somewhat *Disagree

8.      I connect with spirit. *Strongly agree *Somewhat *Disagree

9.      I embrace the unity of all beings. *Strongly agree *Somewhat *Disagree

10.  I am pure light and love *Strongly agree *Somewhat *Disagree

11.  I am connected to the Divine source. *Strongly agree *Somewhat *Disagree

12.  I am connected to my Angels and Guides. *Strongly agree *Somewhat *Disagree

13.  Earthly Attachments can close down our Crown Chakra which affects our Right To know. What aren’t you able to surrender or release? *

 

PRIMEMYCHAKRA’S PROGRAM EVALUATION

1.      Now that you have completed the PrimeMyChakras program, do you feel you have a stronger foundation and are more grounded? Please share examples. *

2.      Do you feel you have healthier relationships with others? Please share examples. *

3.      Do you feel you have a healthier relationship with self? Please share examples. *

4.      Do you feel you have a healthier relationship with self? Please share examples. *

5.      Are you experiencing life now with your heart being more open to giving and receiving love? Please share examples. *

6.      Are you able to speak your truth with more confidence? Please share examples. *

7.      Do you feel more comfortable with trusting your intuition? Please share examples. *

8.      Do you feel you have a stronger faith and connection to All That Is? Please share examples *

9.      How has your experience of abundance changed? Please share examples. *

10.  What is your passion going forward? Would you like to create a goal to help you achieve this vision? *

 

Session Notes: