Remote Energy Testing
RET
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Kyle
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Name
*
First
Last
Email
*
Phone Number
*
Communication Preference
*
Zoom
Facetime
Signal
Telegram
Phone Call
Video or Audio Only
*
Video
Audio Only
What are your Priority Issues? List up to five issues
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Age
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Gender
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Female
Male
Other
List 5 to 15 top foods you eat
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Fluid Intake Daily
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Under 1 Liter
1 - 2 Liters
2 - 3 Liters
3 + Liters
Liquids - click all that you consume
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Tea
Sugary drinks
Coffee
Alcohol
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Never / Rare
Sometimes
Often
How many bowel movements on average / day?
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less than 1
1 - 2
2 - 3
over 3
Sleep Quality
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Poor
Okay
Good / Great
Currently Working
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Yes
No
Stay at home parent / caregiver
Disability
Living Situation
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By self
With family
With friends
With significant relationship/s
Other
State, Country if other than USA
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Housing Type
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House - Rural
House - Suburban
House - Urban
Apartment - Rural
Apartment - Suburban
Aparment - Urban
Stress levels
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Low
Moderate
High
Significant Dental History
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Yes a lot
A few cavities only
Never any dental issues
Physical Trauma History
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Serious injury history
Some broken bones, 10 plus stiches
Broken bone, few stitches
No broken bones, no stiches
Physical Trauma History
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Any significant physical trauma history.
Emotional Trauma History
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A lot
Moderate amount
Not much
Emotional Trauma History
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Not required. Anything significant emotional trauma you wish to share.
Exercise Levels
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None / very little
Moderate amount
Active - weights and cardio multiple times a week
Screen Consumption
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A lot - over 8 hours a day
Moderate - 4 to 8 hours a day
Not much - under 4 hours
Almost none - I'm Amish :)
Belief in Higher Power
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Yes - Above
Yes - Above and Within
Yes - Within
Not Sure
No
I believe in chaos
I believe in myself only
Rather not say
Current Supplements / Medications
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Please list any current supplements / medications you're taking. Ideally include the brand, dose, and frequency.
Please check all 3, or explain why you left any unchecked in 'Additional Comments'.
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My health is worthy of my time and money
I can afford a dollar or two a day for supplements
I am willing to follow a simple and clear Protocol
Any Additional Comments Before Testing
*
Testing will be done right before and during your Session and you can ask any questions then.
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RET
Services
Book Session
Kyle
Reviews
Contact