Track Your Weekly Healing Progress with Vital Energy Medicine

Your progress matters deeply to me. This weekly progress report helps me stay connected to how your body, mind, and energy are responding to our work together. By sharing your honest updates, you help me adjust each session for the best results and keep a clear record of your improvements over time. Please complete this short report once or twice each week as recommended. If you ever have questions or need help, just reach out to me anytime.

Purpose & Use
This form helps me understand your current health challenges and goals so I can tailor your sessions to your unique needs. Your responses also help me observe general patterns of how Vital Energy Medicine may support people facing chronic illness and other long-term health concerns. This is not a medical intake and does not replace medical care. Please answer honestly to support your healing journey and my ongoing learning.

Section 1 -- Basic Information

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

SECTION 2 — Changes Since Last Check-In

• Have you noticed any changes or improvements in the last few days?(Required)

• Have any old symptoms returned or gotten stronger?

• What have you tried so far to support your health?(Required)

• What has helped the most so far?(Required)

• Are there any daily limitations or important concerns you’d like Brendan to know about?(Required)

SECTION 3 — Symptom Overview (Physical)

• Fatigue or low energy(Required)

1 (Very Severe)

2 (Severe)

3 (Moderate)

4 (Mild)

5 (None)

• Muscle or joint discomfort(Required)

1 (Very severe)

2 (Severe)

3 (Mild)

4 (Moderate)

5 (None)

• Sleep issues(Required)

1 (Very Severe)

2 (Severe)

3 (Mild)

4 (Moderate)

5 (None)

• Digestion or stomach discomfort(Required)

1 (Very Severe)

2 (Severe)

3 (Mild)

4 (Moderate)

5 (None)

• Cold hands, feet, or circulation issues(Required)

1 (Very Severe)

2 (Severe)

3 (Mild)

4 (Moderate)

5 (None)

• Hormone or mood fluctuations(Required)

1 (Very severe)

2 (Severe)

3 (Mild)

4 (Moderate)

5 (None)

• Getting sick easily (low immunity)(Required)

1 (Very severe)

2 (Severe)

3 (Mild)

4 (Moderate)

5 (None)

• Low sexual or reproductive energy(Required)

1 (Very severe)

2 (Severe)

3 (Mild)

4 (Moderate)

5 (None)

SECTION 4 — Mental & Emotional Well-Being

• Feeling anxious or tense(Required)

1 (Very severe)

2 (Severe)

3 (Mild)

4 (Moderate)

5 (None)

• Feeling down or discouraged(Required)

1 (Very severe)

2 (Severe)

3 (Mild)

4 (Moderate)

5 (None)

• Excessive worrying or overthinking(Required)

1 (Very severe)

2 (Severe)

3 (Mild)

4 (Moderate)

5 (None)

• Difficulty feeling calm or centered(Required)

1 (Very severe)

2 (Severe)

3 (Mild)

4 (Moderate)

5 (None)

• Difficulty staying positive or hopeful(Required)

1 (Very severe)

2 (Severe)

3 (Mild)

4 (Moderate)

5 (None)

• Difficulty expressing emotions(Required)

1 (Very severe)

2 (Severe)

3 (Mild)

4 (Moderate)

5 (None)

SECTION 5 — Goals & Commitment

• What would you most like to feel, change, or learn through this work?

• What would success look like for you in the next 2–3 months?

• How motivated are you to actively participate in your healing journey?(Required)

1 -- Not ready

2 -- A little ready

3 -- Curious

4 -- Committed

5 -- Fully Committed

Privacy & Sharing
Your answers are used to personalize your sessions, track your progress, and help Vital Energy Medicine understand and share general trends in a way that educates, inspires, and informs others, including potential research partners. We will never share your name or contact information without your explicit written consent.

Consent(Required)

I agree that my self-reported progress data may be used anonymously (without my name or contact information) for educational, promotional, or early research purposes to help others understand the potential benefits of this work.

Thank You
Thank you for taking this important step. Your updates make a real difference in the results we can achieve together. I look forward to supporting you every session and helping you feel stronger, steadier, and more hopeful week by week.

— Brendan Thorson
Vital Energy Medicine

This field is for validation purposes and should be left unchanged.