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P O R T F O L I O
Certified Healer
This portfolio belongs to
_______________________
My purpose
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o Submission)
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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 _____________________________
Notes ___________________________________________________________
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SFQ QI~SSAGE LIVE TRAINING
Instructor ________________________________________________________
DateCompleted_____________Location _____________________________
Notes ___________________________________________________________
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SFQ LEVEL FOUR MEDITATION RETREATCLASS WITH MASTER CHUNYI LIN
Instructor ________________________________________________________
DateCompleted_____________Location _____________________________
Notes ___________________________________________________________
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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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Notes ___________________________________________________________
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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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Tuesday _________________________________________________________
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Wednesday ______________________________________________________
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Thursday ________________________________________________________
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Friday __________________________________________________________
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Saturday ________________________________________________________
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Sunday _________________________________________________________
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READ HEALER ETHICS MANUAL
(No Submission is Required)
Whatimpressedyoumostaboutthismanual? _________________________
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HowwillthismanualinfluenceyourpracticeasaSpringForestQigong
Professional? _____________________________________________________
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Notes ___________________________________________________________
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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
Professional? _____________________________________________________
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Notes ___________________________________________________________
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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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Notes ___________________________________________________________
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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
Professional? _____________________________________________________
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Notes ___________________________________________________________
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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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PracticeG
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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 ____________________________________________________________
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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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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Sessionsw
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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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Sessionsw
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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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Sessionsw
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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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Distance/Q
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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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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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
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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
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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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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
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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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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_________________________
