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Educational Survey
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Desc.ribe your
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initialvisit and cleansing experience
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Details pertaining to overallcomfort and feeling for sterile clean envlronment
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Did this treatment alert you to the rnany unknown benefits from
doing colon hydrotherapy? Explain
what you learned and if you believe cleansing was a total body wake up
call?
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Willyou be doing the minimurn of 5 more sessions?
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Describe how you feel now prior to how you were i:eling before doing
a cleanse
Are you presently taking stool softeners or any
medications to assist with digestion?
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whom
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lf you have experienced a colonic previously,
how would you compare it to the "ANGEL
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Describe your
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Did this treatment alert you to the many unknown benefits
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Will you be doing the rninimurn of 5 more sessions
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Describe how you feel now prior to how you were feeling
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Educational Survey
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Describe your initialvisit and cleansing experience
Details pertaining to overall comfort and feeling for sterile clean environment
Did this treatment alert you to the many unknown benefits from doing colon
hydrotherapv? Explain
wh,alygu learned and if
believe
cleansingwas
a
total
bodywake
up call?
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Describe hory you fegl4oy.prigl.to, how you were feering before doing a creanse
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What were your reasons a nd symptoms for wanting to do col on cleansing?
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Are you presently taking stool softeners or any medications
to assist with digestion?
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Whom
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your MD?
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Have you mentioned colonics to your Dr.?
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Did you prefer the setting and ambiance of a relaxing
atmosphere to be moresE
Uuvduc vs. medical?
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Was this your first colonic?
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Howwouldyou rateyoursession:
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lf you have experienced a colonic previously, how would you
compare it to the ,,ANGEL oF *ATER'?
Additional comments or suggestions (#of sessions you
have done)
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Narne (optional)
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