Body Story Inventory

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Name:
 
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1.

Where do you hold tension in your body?

List location, describe the sensation and length of time you've experienced the feeling (if known).

Example:
Both hands and fingers 5 years prickly feeling and tightness
a.
b.
c.
   
2.
 Where do you have a dis-ease or where do you have a vulnerability to disease?  How often does this symptom appear, or is it chronic?

Example:
Bronchitis in lungs,  recurring usually every 6-8 months
 
   
3.
 Are you ticklish?  If yes, in what areas do you tend to feel ticklish? How long have you experienced this?

Example:
Left side, from age 6 to present
 
   
4.
 What do you feel in your body when you imagine the following significant relationships?  Hold one person in mind at a time.  Notice your breathing, heart rate, tension, sensations and emotion. 
Take your time to notice the location where you feel things in your body.  Describe your awareness.

(The people associated with the following relationships may be living or deceased.)

Check-in with yourself about each.

Example: 
Brother :  my heart rate raises some, subtle tension in belly, a feeling of sadness.
   
 

Spouse/partner relationship
 
   
  Boss / employee / team assistant / colleague
 
   
 

Mother
 
   
 

Father
 
   
 

Siblings
 
   
  Chosen family member(s)
 
   
 

Teacher(s)
 
   
 

Pet
 
   
 

Spirit  (however you define that)
 
   
5.
 What do you feel in your body when you pay your bills (or when you think about your bills being paid by an assistant)?  Again, notice what are the sensations, awarenesses and location of these feelings as you imagine this activity.
 
   
6.
 Feeling of Safety.  In 6a-6g below, check the word that best describes your feeling of safety in the following areas:
6a.
 How safe do you feel in your world?
Not Very Safe
Somewhat Safe   
Safe
Very Safe
       
6b.
 How safe do you feel in your home?
Not Very Safe
Somewhat Safe   
Safe
Very Safe
       
6c.
 How safe do you feel in your business?
Not Very Safe
Somewhat Safe   
Safe
Very Safe
       
6d.
 How safe do you feel while traveling?
Not Very Safe
Somewhat Safe   
Safe
Very Safe
       
6e.
 How safe do you feel in your significant relationship?
Not Very Safe
Somewhat Safe   
Safe
Very Safe
       
6f.
 How safe do you feel in your sexual/erotic relationship?
Not Very Safe
Somewhat Safe   
Safe
Very Safe
       
6g.
 How safe do you feel in your spiritual community?
Not Very Safe
Somewhat Safe   
Safe
Very Safe
       
7.
 Do you already do some form of body care, body therapy or energy work? Check those you are doing (within the past two months)
 
Yoga
 Tai Chi Chi Gong Watsu
  Reiki Massage Feldenkreis Breathwork
  Erotic Body Therapies Aerobic Exercise Acupuncture
  Weight-bearing Exercise Bioenergetics
 
Other:
         
8.
 Do you have an addiction or a tendency towards addictive behavior? Circle the one or those that apply:
  Food Drugs Alcohol Money/Gambling
  Shopping Sex    
 
Other:
         

 

9.
 Have you ever been emotionally, physically or sexually abused? Abuse may also be defined in non-direct terms like neglect, etc. What do you feel in your body when you think about this/these experiences?
 
   
10.
 What do you feel in your body when you imagine being free of any emotional blocks?
 
   
11.
 What do you feel in your body when you are afraid or when you are approaching conflict?
 
   
12.
 When you experience compassion, what do you feel in your body?
 
   
13.
 What does it feel like to be powerful in your body?  Where do you feel it?
 
   
14.
 In what area(s) of your life do you want to experience more abundance?
 
   
15.
 How did you hear about this inventory?
 
 

Just by answering these questions honestly you have brought some loving attention to yourself. Be compassionate with yourself; compassion will heal you.

By submitting this form, you will receive a FREE twenty minute one-on-one consultation to discuss your inventory. A loving member of our staff will be in contact with you shortly to set up your consultation.