REOOT HEALING

Pre Session Form

If you are allergic to forms you do not have to fill this out .
You do not have to tell me anything before we do a ROOT HEALING session.
But if you WANT the following could be of some importance.
Nothing in this form will lead to your person. No name is asked, no address, no landline
phone number. And we will NOT note your name on this page.
Pls simply download this page to your screen, write into it and send it to
mark.roothealing@gmail.com

Age:43
Gender: Masculine
Living: At this moment , in my parents house.

with a/or both parents, alone, with friend(s), with girl-/boy-friend, as a married
couple, otherwise (pls underline/explain).
Do you have children? No. How many?
What is your occupation? Engineer, but unemployed for some time
Do you like it? When working feels good making money, but some areas I do not
like such as communicating with troublesome coworkers
What have you originally learned?
What would you rather like to do as a job? I would like to have a Job where I
could use other parts of my mind but at the same time been able to make a living
out of it.
What is your basic problem?

I feel I can connect easily with People or that I am not normally interested in the
subjects they like to talk about. Specially would like to be able to communicate
better.

What is your most fundamental truth?

I do not know

Are you actively practicing a religion?

I used to practice a esoteric religion for 15 years, and just got out of it , 2 years
ago when finding out it simply was hooey. Now I find myself struggling with many
religious beliefs or influences in my mind that I see do not help me on my day to
day interactions with events in my life and People in gral.

How is your general health? Good

Do you have a certain (several) specific health problem(s)? I used to have Asthma
as a Child, but eventually it got under control, by exercising , meditating ,etc.
Nowdays I still feel Asthma simptoms when weather gets too Humid.
Do you normally have warm or cold hands, warm or cold feet?
Coold feet sometimes
Are you often tired? No

Do you forget things a lot? No

Are you anxious ? No
How would you describe your normal mood ?
Often depressed, sometimes depressed, often sad, sometimes sad, no mood, no
feelings, often bad mood, sometimes bad mood, sometimes angry, often angry,
sometimes bored, often bored, sometimes interested in life and things, mostly
interested in life and things. (Pls underline all that is TRUE).

Is your mood changing up and down for no raesons?

Only when I compare myself with other People that did not go through the same
beliefs as I went.
Are you thinking a lot about the past ? Oh yes, overall about all thinks that I
believed it was truth (like beliefs I learn while I was in Religion), and quite often
blaming myself for being such Naive.
Do have experienced something you can not come over it?
well, i guess , now not being able to determine what is exactly what I want out of
life, where I want to live and how I want to make a living.
Do you have a problem with a certain person that does not go away?
No.
____________________________________________________________________
Do you have good friends?
one or two, but we do get together quite often
, more, several, many? (Pls underline)
On a scale from 1 10, 10 being the best, how would you rate your overall
happiness?
6
Are you a daydreamer ? Yes i think so
Do you have goals? I have many thinks I would like to accomplish, some long
term and some short term

If you do, then on a scale from 1 10, 10 being the best, how would you rate your
ability to progress toward your goal(s) ?
6
Do you have something stopping you but dont know what it is?
Yes.

Do you have something stopping you and you know what it is? What is it?
I can only guess, maybe , there is a confusion between my previous Spiritual
Goals and my now Material Goals, I am not sure which ones I should give my full
attention. My attention is scatered, sometimes I see life from an Spiritual
perspective , sometime from a Material perspective with different outlooks .
Also I feel a sense of lack of skills for Material goals (communication and
expression) that are not Job-related things.

On a scale of 1 10 (10 being the best) how able, self certain and self assured
would you think you are?
6
What would you need to be more effective?
To get Skills I currently sense I do not posses.
Being able to determine what I want to do, how I want to do it ,I developing the
Skills I need

What would you need to be more happy?

Clear Vision, Clear certainty of Spiritual matters and Material life.
____________________________________________________________________
Did you learn any therapies or self-development practices?
yes I lot. Meditation, Gigong,Mantrams,etc (practiced until 3 years ago)

Have you practiced this (these) thing(s) with others?

yes Shallow PEAT, and DP4
Do you still practice some healing- or self-development- or spiritual techniques
with yourself / with others?
I am trying to come back to Spiritual Techniques and apply them to myself , like
Aspectics, Self-Clearing,QiGong,Meditation,etc.

Have you experienced something specially positive/or specially negative when

doing these practices? What was it?
No
____________________________________________________________________
Do you take any street-drugs (even if not frequently)? No
Do you take medicine regularly? What? No
Do you have a history of taking street drugs? No
Have you been in psychiatric treatement? No
What for?
What was your experience with this?
Do you take any psycho medicine ?No
Do you have any addiction?No
All considered: Why are you interested to have a session with me ?
I been a lurker for some time in Tech4Reality group, and saw your website and
your techniques
What do you expect to achieve in this session with me?
A sense of feeling better, to know better your therapy as I would want to learn and
apply this types of Therapies to some clients.
_____________________________________________________________________
Where do you live (Town or next big town)? in Mexico, in the country side.
What is your local time zone ? CST
What is the time difference (+ or - ) to Kuala Lumpur (Malaysia)?
My time to give sessions (start time) is from 10.00 am to 20.00 pm.
PLs give me the time, converted to my local time within this time frame and the date
you would like to have a session: _________________________________

Please send this filled out form to mark.roothealing@gmail.com . Thank you.

Mark