All rights reserved 2019 EgyptianSky

TO OBTAIN ANY OF THE SERVICES, PLEASE FILL OUT
AND SUBMIT THIS QUESTIONNAIRE

SECTION TWO QUESTIONS SOCIAL INFORMATION

 (You May Elaborate Your Answers In The Section #2 Blank Page at The End)

SECTION THREE QUESTIONS HEALTH INFORMATION

(You May Elaborate Your Answers In The Section #3 Blank Page at The End)

Each Week?

SECTION FOUR QUESTIONS WOMEN’S or MEN’S HEALTH INFORMATION

 (You May Elaborate Your Answers In The Section #3 Blank Page at The End)

Do you have any concerns about your sexual, reproductive track or urinary track organ’s well-being? For example: fibroids? enlarged prostate? ED problem? endo- metriosis? polycystic ovaries? prolapsed or tilted uterus? dryness, or yeast infec- tion?  Vaginal Steaming is a palliative service that can help you feel better, help you to practice self-soothing, calming yourself from nervousness about your  condition and feel comforted. It is not a medical treatment nor cure for medical disorders per se). 

Note: In cases of pregnancy (or where a client plans to become pregnant), infer- tility, or IUD maladjustment, active menstruation, after in-vitro fertilizations, heavy bleeding, hot flashes, or during miscarriages Yoni steaming and Yoni womb massage are not indicated and are, indeed, prohibited. The client must inform the facilitator, immediately Please list any of these prohibited conditions:

SECTION FIVE QUESTIONS MEDICAL and PSYCHOLOGICAL INFORMATION

 (You May Elaborate Your Answers In The Section #5 Blank Page at The End) 

Do you take any supplements or medications?  Please explains:

SECTION SIX QUESTIONS DIETARY INFORMATION 

 (You May Elaborate Your Answers In The Section #5 Blank Page at The End)

What foods did you eat most as a child?

What foods do you eat most now?

SECTION ONE ANSWERS    

Personal Information

SECTION TWO ANSWERS    

Social Information

 SECTION THREE ANSWERS    

General Health Information

Women’s / Men’s Health Information

SECTION FOUR ANSWERS    

SECTION FIVE ANSWERS    

Health Information

Dietary Information

SECTION SIX ANSWERS    

Exercise?