0%
Worksheet

Level 1 Final Evaluation

Please read each question carefully and answer honestly with where you're currently at after completing the Regulate™ program.

1. ➜

How many months have you spent on the Regulate™ program?

2. ➜

Physical Function: What is your overall functional capacity AFTER completing Regulate™?

1 being the lowest score "I am bedbound and/or housebound"

10 being the highest score "I am physically able to engage in all of the daily activities I desire"

3. ➜

Emotional/Mental Function: AFTER completing Regulate™, how much of your day are you experiencing a stress response?

1 being the lowest stress score "I rarely feel stressed"

10 being the highest stress score "I always feel stressed"

4. ➜

If you have had fatigue: What would you rate the fatigue you experience AFTER completing Regulate™?

1 being the best "I now experience no fatigue"

10 being the worst "I have had no improvement in fatigue - I still experience the same exhaustion"

5. ➜

If you have had pain: What would you rate the pain you experience AFTER completing Regulate™?

1 being the least "I now have no pain"

10 being the worst  "I have had no improvement - I still experience the same amount of pain"

6. ➜

AFTER completing Regulate™, in comparison to how you felt before, on a scale of 1-10, which of these statements do you feel most resonates with your current quality of life?

1 being the least "I find it challenging to maintain a sense of well-being and purpose in life"

10 being the best "I feel a strong sense of well-being and purpose in life"

7. ➜

Did you undertake other treatments/programs alongside the Regulate™ course?

8. ➜

Have you implemented at least a basic nervous system regulation routine?

9. ➜

Please provide a summary or testimonial of your experience with Level 1 Regulate™ and describe the improvements that you have had from completing the program

10. ➜

We'd love to share your experience with the Primal Trust™ Community and/or Instagram and our website!

11. ➜

Would you recommend Primal Trust™ to your friends and family?

12. ➜

We'd love to share a photo alongside your testimonial!

If you selected to share your experience publicly, please upload a photo of yourself here.

A photo helps others connect with your story on a more personal level — giving inspiration for those searching for healing.

By uploading your photo, you’re giving us permission to share it alongside your testimonial on our website or social media.

powered by
Simplero