Daily Practices SurveyHealing Wheel Retreats - A Self Reflective Name * First Name Last Name Email * Phone (###) ### #### Do you have daily practice? Yes No How much sleep do you get and what time do you go to bed? Less than 6 hours 6-7 hours 7-8 hours More than 8 hours Do you have time you “wind down”? If so, how? (please specify) What is your current morning routine? What is your current afternoon routine? What is your evening routine? How often do you exercise? 3-5 times a week 1-2 times a week Rarely Never What is your fitness routine? Be as specific as you can Do you have fasting periods in your day? If yes, please specify the fasting period. How much caffeine do you consume daily? None Less than 100 mg 100-200 mg 200-400 mg More than 400 mg How much water do you drink daily and what kind? Do you take supplements? If yes, please specify the type. Do you have a skincare routine? Yes No Do you have an oral care routine? Yes No Do you practice meditation? Yes No Do you engage in prayer or spiritual practices? Yes No Do you practice breathwork? Yes No Do you engage in creative activities regularly? Yes No Do you monitor your hormonal health? Yes No How would you rate your libido? Very low Low Moderate High Very high How often do you laugh on a typical day? Rarely Occasionally Several times Frequently Constantly Feel free to add any additional comments or details about your daily practices and routines: Thank you! Thank you for participating! -Melissa and RussYou can purchase our best selling book here!Daily Practices- A Mindfulness Companion
