Certified Healer - s3.ca-central-1.amazonaws.com · PREREQUISITES (No Submission) 5 Prerequisites...

P O R T F O L I O

Certified Healer

This portfolio belongs to

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My purpose

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www.springforestqigong.com

SCAN AND EMAIL COMPLETED FORMS TO:

certification@springforestqigong.com

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Prerequisites

q Spring Forest Qigong Certified Practice Group Leader

• CompleteSpringForestQigongLevelOneforHealthLiveTrainingwithaqualifiedinstructor.

• CompleteSpringForestQigongLevelTwoforHealingLiveTrainingwithaqualifiedinstructor.

• CompleteSpringForestQigongFiveElementHealingMovementsself-studyprogramorlivetrainingwithaqualifiedinstructor.

q Spring Forest Qigong Certified Trainer

• BeaCertifiedPracticeGroupLeader.

• SpringForestQigongLevelThreeforAdvancedEnergyDevelopmentandHealingLiveTrainingwithaqualifiedinstructor.

q Spring Forest Qigong Certified Healer

• BeaCertifiedPracticeGroupLeader.

• SpringForestQigongLevelThreeforAdvancedEnergyDevelopment andHealingLiveTrainingwithaqualifiedinstructor.

• CompleteSpringForestQigongQi~ssageLiveTrainingwithaqualifiedinstructor.

• CompleteSpringForestQigongLevel4MeditationRetreat.

q Spring Forest Qigong Certified Qi~ssage Healer

• BeaSpringForestQigongCertifiedHealer.

q Spring Forest Qigong Certified Instructor

• BeaSpringForestQigongCertifiedTrainer.

• BeaSpringForestQigongCertifiedHealer.

• Complete Finding your Soul Purpose: Transforming Your Lifeaudioprogram.

• Complete 24 Steps to Awaken the Master Withinaudioprogram.

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SFQ LEVEL THREE FOR ADVANCED HEALING LIVE TRAINING

Instructor ________________________________________________________

DateCompleted_____________Location _____________________________

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SFQ QI~SSAGE LIVE TRAINING

Instructor ________________________________________________________

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SFQ LEVEL FOUR MEDITATION RETREATCLASS WITH MASTER CHUNYI LIN

Instructor ________________________________________________________

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Portfolio RequirementsNo submission is required

q Practice Spring Forest Qigong for a minimum of 60 minutes a day.

q Keep daily journal describing personal growth through Spring Forest Qigong practice, meditation, practice group, and performing healing.

q Read:

Healer Ethics Manual

q Complete and pass online Healer Ethics Exam

q Read: Born a Healer,byChunyiLin

Head to Toe Healing: Your Body’s Repair Manual,byChunyiLin

q Be able to apply the techniques in the book Head to Toe Healing: Your Body’s Repair Manual

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PRACTICE SPRING FOREST QIGONG FOR A MINIMUM OF 60 MINUTES A DAY

(No Submission is Required)

WhatisyourfavoriteQigongMeditation? _____________________________

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WhatisyourfavoriteQigongMovement? _____________________________

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DAILY JOURNAL {MAKE AS MANY COPIES AS NEEDED} DESCRIBE PERSONAL GROWTH THROUGH SFQ PRACTICE, MEDITATION,

PRACTICE GROUP SESSIONS, AND HEALING SESSIONS (No Submission is Required)

Monday _________________________________________________________

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READ HEALER ETHICS MANUAL

(No Submission is Required)

Whatimpressedyoumostaboutthismanual? _________________________

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HowwillthismanualinfluenceyourpracticeasaSpringForestQigong

Professional? _____________________________________________________

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COMPLETED ETHICS EXAM–WITH A SCORE OF 100% (No Submission is Required)

Whatdidyoulearnaboutethics? ____________________________________

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HowwillethicsinfluenceyourpracticeasaSpringForestQigong

Professional? ____________________________________________________

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Whatareasofethicsdoyoufeelyouneedtobemostawareof? __________

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READ BORN A HEALER, BY CHUNYI LIN (No Submission is Required)

Whatimpressedyoumostaboutthisbook? ___________________________

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HowwillthisbookinfluenceyourpracticeasaSpringForestQigong

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READ HEAD TO TOE HEALING: YOUR BODY’S REPAIR MANUAL, BY CHUNYI LIN

(No Submission is Required)

Whatimpressedyoumostaboutthisbook? ___________________________

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HowwillthisbookinfluenceyourpracticeasaSpringForestQigong

Professional? _____________________________________________________

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BE ABLE TO APPLY THE TECHNIQUES FROM THE BOOKHEAD TO TOE HEALING: YOUR BODY’S REPAIR MANUAL

(No Submission is Required)

Whatimpressedyoumostaboutthesetechniques? _____________________

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HowwillthesetechniquesinfluenceyourpracticeasaSpringForestQigong

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Portfolio RequirementsSubmission is required

Practicumofdocumentedresults/testimonials foratotalof90SpringForestQigonghealingsessions.

Minimum30hoursleadingaPracticeGroup

Breakdown of 90 Sessions

q 60 Qigong healing sessions in person: •40differentindividuals

•Remaining20canbeneworrepeatindividuals

q 30 distance Qigong healing sessions

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The following healing sessions with feedback forms and case studies can be part of the 60 Qigong in-person healings

q 10 Qigong healing sessions with feedback form signed by person who received the healing

q 3 case studies that involve working with a person for 3 or more sessions and determining outcome from those sessions

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30 Spring Forest Qigong Practice Group Sessions

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PRACTICE GROUP SESSIONS(Required to submit)

Healer Name _______________________________________

1. Practice Group Location __________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

2. Practice Group Location __________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

3. Practice Group Location __________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

4. Practice Group Location __________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

5. Practice Group Location __________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

6. Practice Group Location __________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

7. Practice Group Location __________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

8. Practice Group Location __________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

9. Practice Group Location __________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

10. Practice Group Location _________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

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PRACTICE GROUP SESSIONS(Required to submit)

Healer Name _______________________________________

11. Practice Group Location _________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

12. Practice Group Location _________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

13. Practice Group Location _________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

14. Practice Group Location _________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

15. Practice Group Location _________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

16. Practice Group Location _________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

17. Practice Group Location _________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

18. Practice Group Location _________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

19. Practice Group Location _________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

20. Practice Group Location ________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

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PRACTICE GROUP SESSIONS(Required to submit)

Healer Name _______________________________________

21. Practice Group Location _________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

22. Practice Group Location ________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

23. Practice Group Location ________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

24. Practice Group Location ________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

25. Practice Group Location ________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

26. Practice Group Location ________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

27. Practice Group Location _________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

28. Practice Group Location ________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

29. Practice Group Location _________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

30. Practice Group Location ________________________________________________

Date_________________NumberofAttendees_________LengthofSession _________

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60 Spring Forest Qigong Healing Sessions

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CLIENT HEALING SESSIONS – 40 DIFFERENT INDIVIDUALS(Required to submit)

Healer Name _______________________________________

1. Client Name ____________________________________________________________

Date_______________________

2. Client Name ____________________________________________________________

Date_______________________

3. Client Name ____________________________________________________________

Date_______________________

4. Client Name ____________________________________________________________

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5. Client Name ____________________________________________________________

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6. Client Name ____________________________________________________________

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7. Client Name ____________________________________________________________

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8. Client Name ____________________________________________________________

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9. Client Name ____________________________________________________________

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10. Client Name ___________________________________________________________

Date_______________________

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CLIENT HEALING SESSIONS – 40 DIFFERENT INDIVIDUALS(Required to submit)

Healer Name _______________________________________

11. Client Name ___________________________________________________________

Date_______________________

12. Client Name ___________________________________________________________

Date_______________________

13. Client Name ___________________________________________________________

Date_______________________

14. Client Name ___________________________________________________________

Date_______________________

15. Client Name ___________________________________________________________

Date_______________________

16. Client Name ___________________________________________________________

Date_______________________

17. Client Name ___________________________________________________________

Date_______________________

18. Client Name ___________________________________________________________

Date_______________________

19. Client Name ___________________________________________________________

Date_______________________

20. Client Name ___________________________________________________________

Date_______________________

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CLIENT HEALING SESSIONS – 40 DIFFERENT INDIVIDUALS(Required to submit)

Healer Name _______________________________________

21. Client Name ___________________________________________________________

Date_______________________

22. Client Name ___________________________________________________________

Date_______________________

23. Client Name ___________________________________________________________

Date_______________________

24. Client Name ___________________________________________________________

Date_______________________

25. Client Name ___________________________________________________________

Date_______________________

26. Client Name ___________________________________________________________

Date_______________________

27. Client Name ___________________________________________________________

Date_______________________

28. Client Name ___________________________________________________________

Date_______________________

29. Client Name ___________________________________________________________

Date_______________________

30. Client Name ___________________________________________________________

Date_______________________

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CLIENT HEALING SESSIONS – 40 DIFFERENT INDIVIDUALS(Required to submit)

Healer Name _______________________________________

31. Client Name ___________________________________________________________

Date_______________________

32. Client Name ___________________________________________________________

Date_______________________

33. Client Name ___________________________________________________________

Date_______________________

34. Client Name ___________________________________________________________

Date_______________________

35. Client Name ___________________________________________________________

Date_______________________

36. Client Name ___________________________________________________________

Date_______________________

37. Client Name ___________________________________________________________

Date_______________________

38. Client Name ___________________________________________________________

Date_______________________

39. Client Name ___________________________________________________________

Date_______________________

40. Client Name ___________________________________________________________

Date_______________________

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CLIENT HEALING SESSIONS – 20 REPEAT OR NEW INDIVIDUALS(Required to submit)

Healer Name _______________________________________

41. Client Name ___________________________________________________________

Date_______________________

42. Client Name ___________________________________________________________

Date_______________________

43. Client Name ___________________________________________________________

Date_______________________

44. Client Name ___________________________________________________________

Date_______________________

45. Client Name ___________________________________________________________

Date_______________________

46. Client Name ___________________________________________________________

Date_______________________

47. Client Name ___________________________________________________________

Date_______________________

48. Client Name ___________________________________________________________

Date_______________________

49. Client Name ___________________________________________________________

Date_______________________

50. Client Name ___________________________________________________________

Date_______________________

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CLIENT HEALING SESSIONS – 20 REPEAT OR NEW INDIVIDUALS(Required to submit)

Healer Name _______________________________________

51. Client Name ___________________________________________________________

Date_______________________

52. Client Name ___________________________________________________________

Date_______________________

53. Client Name ___________________________________________________________

Date_______________________

54. Client Name ___________________________________________________________

Date_______________________

55. Client Name ___________________________________________________________

Date_______________________

56. Client Name ___________________________________________________________

Date_______________________

57. Client Name ___________________________________________________________

Date_______________________

58. Client Name ___________________________________________________________

Date_______________________

59. Client Name ___________________________________________________________

Date_______________________

60. Client Name ___________________________________________________________

Date_______________________

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10 Spring Forest Qigong Healing Sessions

with Feedback Form

Completed by 10 Different Individuals**Individuals can be from the previous 60 Qigong healing sessions.

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#1CLIENT FEEDBACK FORM–MINIMUM OF 10

(Required to submit)

Healer Name _______________________________________

Client Name ______________________________________________________________Date___________________Durationofsession __________________________________

Session Type: q Qigong qDistance

Client’s Initial Areas of Concern: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Existing Clients:Whatareyouexperiencing,includinganychangesfromlastsession?______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Blockages Noted by Healer: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Recommendations for Client’s Self-care Plan:qDailyqWeeklyqEveryotherweekqMonthlyqAsneeded______________________________________________________________________________________________________________________________________________________________________________________________________________________________

ClientSignature________________________________________Date ________________

HealerSignature________________________________________Date ________________

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#2CLIENT FEEDBACK FORM–MINIMUM OF 10

(Required to submit)

Healer Name _______________________________________

Client Name ______________________________________________________________Date___________________Durationofsession __________________________________

Session Type: q Qigong qDistance

Client’s Initial Areas of Concern: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Existing Clients:Whatareyouexperiencing,includinganychangesfromlastsession?______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Blockages Noted by Healer: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Recommendations for Client’s Self-care Plan:qDailyqWeeklyqEveryotherweekqMonthlyqAsneeded______________________________________________________________________________________________________________________________________________________________________________________________________________________________

ClientSignature________________________________________Date ________________

HealerSignature________________________________________Date ________________

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#3CLIENT FEEDBACK FORM–MINIMUM OF 10

(Required to submit)

Healer Name _______________________________________

Client Name ______________________________________________________________Date___________________Durationofsession __________________________________

Session Type: q Qigong qDistance

Client’s Initial Areas of Concern: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Existing Clients:Whatareyouexperiencing,includinganychangesfromlastsession?______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Blockages Noted by Healer: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Recommendations for Client’s Self-care Plan:qDailyqWeeklyqEveryotherweekqMonthlyqAsneeded______________________________________________________________________________________________________________________________________________________________________________________________________________________________

ClientSignature________________________________________Date ________________

HealerSignature________________________________________Date ________________

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#4CLIENT FEEDBACK FORM–MINIMUM OF 10

(Required to submit)

Healer Name _______________________________________

Client Name ______________________________________________________________Date___________________Durationofsession __________________________________

Session Type: q Qigong qDistance

Client’s Initial Areas of Concern: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Existing Clients:Whatareyouexperiencing,includinganychangesfromlastsession?______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Blockages Noted by Healer: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Recommendations for Client’s Self-care Plan:qDailyqWeeklyqEveryotherweekqMonthlyqAsneeded______________________________________________________________________________________________________________________________________________________________________________________________________________________________

ClientSignature________________________________________Date ________________

HealerSignature________________________________________Date ________________

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#5CLIENT FEEDBACK FORM–MINIMUM OF 10

(Required to submit)

Healer Name _______________________________________

Client Name ______________________________________________________________Date___________________Durationofsession __________________________________

Session Type: q Qigong qDistance

Client’s Initial Areas of Concern: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Existing Clients:Whatareyouexperiencing,includinganychangesfromlastsession?______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Blockages Noted by Healer: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Recommendations for Client’s Self-care Plan:qDailyqWeeklyqEveryotherweekqMonthlyqAsneeded______________________________________________________________________________________________________________________________________________________________________________________________________________________________

ClientSignature________________________________________Date ________________

HealerSignature________________________________________Date ________________

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#6CLIENT FEEDBACK FORM–MINIMUM OF 10

(Required to submit)

Healer Name _______________________________________

Client Name ______________________________________________________________Date___________________Durationofsession __________________________________

Session Type: q Qigong qDistance

Client’s Initial Areas of Concern: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Existing Clients:Whatareyouexperiencing,includinganychangesfromlastsession?______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Blockages Noted by Healer: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Recommendations for Client’s Self-care Plan:qDailyqWeeklyqEveryotherweekqMonthlyqAsneeded______________________________________________________________________________________________________________________________________________________________________________________________________________________________

ClientSignature________________________________________Date ________________

HealerSignature________________________________________Date ________________

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#7CLIENT FEEDBACK FORM–MINIMUM OF 10

(Required to submit)

Healer Name _______________________________________

Client Name ______________________________________________________________Date___________________Durationofsession __________________________________

Session Type: q Qigong qDistance

Client’s Initial Areas of Concern: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Existing Clients:Whatareyouexperiencing,includinganychangesfromlastsession?______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Blockages Noted by Healer: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Recommendations for Client’s Self-care Plan:qDailyqWeeklyqEveryotherweekqMonthlyqAsneeded______________________________________________________________________________________________________________________________________________________________________________________________________________________________

ClientSignature________________________________________Date ________________

HealerSignature________________________________________Date ________________

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#8CLIENT FEEDBACK FORM–MINIMUM OF 10

(Required to submit)

Healer Name _______________________________________

Client Name ______________________________________________________________Date___________________Durationofsession __________________________________

Session Type: q Qigong qDistance

Client’s Initial Areas of Concern: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Existing Clients:Whatareyouexperiencing,includinganychangesfromlastsession?______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Blockages Noted by Healer: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Recommendations for Client’s Self-care Plan:qDailyqWeeklyqEveryotherweekqMonthlyqAsneeded______________________________________________________________________________________________________________________________________________________________________________________________________________________________

ClientSignature________________________________________Date ________________

HealerSignature________________________________________Date ________________

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#9CLIENT FEEDBACK FORM–MINIMUM OF 10

(Required to submit)

Healer Name _______________________________________

Client Name ______________________________________________________________Date___________________Durationofsession __________________________________

Session Type: q Qigong qDistance

Client’s Initial Areas of Concern: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Existing Clients:Whatareyouexperiencing,includinganychangesfromlastsession?______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Blockages Noted by Healer: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Recommendations for Client’s Self-care Plan:qDailyqWeeklyqEveryotherweekqMonthlyqAsneeded______________________________________________________________________________________________________________________________________________________________________________________________________________________________

ClientSignature________________________________________Date ________________

HealerSignature________________________________________Date ________________

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#10CLIENT FEEDBACK FORM–MINIMUM OF 10

(Required to submit)

Healer Name _______________________________________

Client Name ______________________________________________________________Date___________________Durationofsession __________________________________

Session Type: q Qigong qDistance

Client’s Initial Areas of Concern: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Existing Clients:Whatareyouexperiencing,includinganychangesfromlastsession?______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Blockages Noted by Healer: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Recommendations for Client’s Self-care Plan:qDailyqWeeklyqEveryotherweekqMonthlyqAsneeded______________________________________________________________________________________________________________________________________________________________________________________________________________________________

ClientSignature________________________________________Date ________________

HealerSignature________________________________________Date ________________

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i~ssageSessions

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30 Distance Qigong Healing Sessions

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DistanceQ

igongSessions

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CLIENT DISTANCE QIGONG HEALING SESSIONS – MINIMUM OF 30

Healer Name _______________________________________

1. Client Name ____________________________________________________________

Date_____________________________________

2. Client Name ____________________________________________________________

Date_____________________________________

3. Client Name ____________________________________________________________

Date_____________________________________

4. Client Name ____________________________________________________________

Date_____________________________________

5. Client Name ____________________________________________________________

Date_____________________________________

6. Client Name ____________________________________________________________

Date_____________________________________

7. Client Name ____________________________________________________________

Date_____________________________________

8. Client Name ____________________________________________________________

Date_____________________________________

9. Client Name ____________________________________________________________

Date_____________________________________

10. Client Name ___________________________________________________________

Date_____________________________________

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DistanceQ

igongSessions

CLIENT DISTANCE QIGONG HEALING SESSIONS – MINIMUM OF 30

Healer Name _______________________________________

11. Client Name ___________________________________________________________

Date_____________________________________

12. Client Name ___________________________________________________________

Date_____________________________________

13. Client Name ___________________________________________________________

Date_____________________________________

14. Client Name ___________________________________________________________

Date_____________________________________

15. Client Name ___________________________________________________________

Date_____________________________________

16. Client Name ___________________________________________________________

Date_____________________________________

17. Client Name ___________________________________________________________

Date_____________________________________

18. Client Name ___________________________________________________________

Date_____________________________________

19. Client Name ___________________________________________________________

Date_____________________________________

20. Client Name ___________________________________________________________

Date_____________________________________

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DistanceQ

igongSessions

CLIENT DISTANCE QIGONG HEALING SESSIONS – MINIMUM OF 30

Healer Name _______________________________________

21. Client Name ___________________________________________________________

Date_____________________________________

22. Client Name ___________________________________________________________

Date_____________________________________

23. Client Name ___________________________________________________________

Date_____________________________________

24. Client Name ___________________________________________________________

Date_____________________________________

25. Client Name ___________________________________________________________

Date_____________________________________

26. Client Name ___________________________________________________________

Date_____________________________________

27. Client Name ___________________________________________________________

Date_____________________________________

28. Client Name ___________________________________________________________

Date_____________________________________

29. Client Name ___________________________________________________________

Date_____________________________________

30. Client Name ___________________________________________________________

Date_____________________________________

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CaseStudies

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Case Studies for 3 Sessions

Individuals can be from the previous 60 Qigong Healing Sessions

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CaseStudies

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Client Name ______________________________________________________________Date________________________________

Subjective Client Complaints

Description Dates

MainComplaint

Onset

Qualityofsymptoms

Isthereanyotherplacethesesymptomsappear

Siteofthesymptoms

Timeofday/durationofthesymptoms(aretheyworseatacertaintime/howlongdotheylast

Priorhealthhistory

Characteristicsofsymptomsbasedon5ElementTheory

#1CASE STUDY FORM–MINIMUM OF 3

(Required to submit)

Healer Name _______________________________________

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46

Description Dates

Objectivefindings:Whatdidyoufindonexamination?

Howdidclientappeartoyou?Whatdidyounoticeabouttheclient?

Healing Session 1eatment 1

HealingSessiontimeandduration _____________________________________________________

Client’sresponseforthesession _______________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healer’snoteandcommentsforthesession _____________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healing Session 2eatment 1

HealingSessiontimeandduration _____________________________________________________

Client’sresponseforthesession _______________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healer’snoteandcommentsforthesession _____________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healing Session 3eatment 1

HealingSessiontimeandduration _____________________________________________________

Client’sresponseforthesession _______________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healer’snoteandcommentsforthesession _____________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Subjective Client Complaints (continued)

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www.springforestqigong.com

Healer’s summary of overall study regarding this client’s energy physically, emotionally, mentally, etc. ______________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healing Summary

Whatchangedfromtheclient’sperspective? _____________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Whatchangedfromyourperspective? __________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Comments/testimonialsfromtheclient _________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Personalcommentsfromthehealer ____________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healer Signature

Bysubmittingthisapplication,Iaffirmthatthefactssetforthinitaretrueandcomplete.

Signature_____________________________________________ Date_________________________

48

PO

RT

FO

LIO

CaseStudies

Client Name ______________________________________________________________Date________________________________

Subjective Client Complaints

Description Dates

MainComplaint

Onset

Qualityofsymptoms

Isthereanyotherplacethesesymptomsappear

Siteofthesymptoms

Timeofday/durationofthesymptoms(aretheyworseatacertaintime/howlongdotheylast

Priorhealthhistory

Characteristicsofsymptomsbasedon5ElementTheory

#2CASE STUDY FORM–MINIMUM OF 3

(Required to submit)

Healer Name _______________________________________

www.springforestqigong.com

49

PO

RT

FO

LIO

CaseStudies

Description Dates

Objectivefindings:Whatdidyoufindonexamination?

Howdidclientappeartoyou?Whatdidyounoticeabouttheclient?

Healing Session 1eatment 1

HealingSessiontimeandduration _____________________________________________________

Client’sresponseforthesession _______________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healer’snoteandcommentsforthesession _____________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healing Session 2eatment 1

HealingSessiontimeandduration _____________________________________________________

Client’sresponseforthesession _______________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healer’snoteandcommentsforthesession _____________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healing Session 3eatment 1

HealingSessiontimeandduration _____________________________________________________

Client’sresponseforthesession _______________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healer’snoteandcommentsforthesession _____________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Subjective Client Complaints (continued)

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50

PO

RT

FO

LIO

CaseStudies

www.springforestqigong.com

Healer’s summary of overall study regarding this client’s energy physically, emotionally, mentally, etc. ______________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healing Summary

Whatchangedfromtheclient’sperspective? _____________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Whatchangedfromyourperspective? __________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Comments/testimonialsfromtheclient _________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Personalcommentsfromthehealer ____________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healer Signature

Bysubmittingthisapplication,Iaffirmthatthefactssetforthinitaretrueandcomplete.

Signature_____________________________________________ Date_________________________

51

PO

RT

FO

LIO

CaseStudies

Client Name ______________________________________________________________Date________________________________

Subjective Client Complaints

Description Dates

MainComplaint

Onset

Qualityofsymptoms

Isthereanyotherplacethesesymptomsappear

Siteofthesymptoms

Timeofday/durationofthesymptoms(aretheyworseatacertaintime/howlongdotheylast

Priorhealthhistory

Characteristicsofsymptomsbasedon5ElementTheory

#3CASE STUDY FORM–MINIMUM OF 3

(Required to submit)

Healer Name _______________________________________

www.springforestqigong.com

52

PO

RT

FO

LIO

CaseStudies

Description Dates

Objectivefindings:Whatdidyoufindonexamination?

Howdidclientappeartoyou?Whatdidyounoticeabouttheclient?

Healing Session 1eatment 1

HealingSessiontimeandduration _____________________________________________________

Client’sresponseforthesession _______________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healer’snoteandcommentsforthesession _____________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healing Session 2eatment 1

HealingSessiontimeandduration _____________________________________________________

Client’sresponseforthesession _______________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healer’snoteandcommentsforthesession _____________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healing Session 3eatment 1

HealingSessiontimeandduration _____________________________________________________

Client’sresponseforthesession _______________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healer’snoteandcommentsforthesession _____________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Subjective Client Complaints (continued)

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53

PO

RT

FO

LIO

CaseStudies

www.springforestqigong.com

Healer’s summary of overall study regarding this client’s energy physically, emotionally, mentally, etc. ______________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healing Summary

Whatchangedfromtheclient’sperspective? _____________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Whatchangedfromyourperspective? __________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Comments/testimonialsfromtheclient _________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Personalcommentsfromthehealer ____________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Healer Signature

Bysubmittingthisapplication,Iaffirmthatthefactssetforthinitaretrueandcomplete.

Signature_____________________________________________ Date_________________________

54

SCAN AND EMAIL COMPLETED FORMS TO:

certification@springforestqigong.com

www.springforestqigong.com