Your Weekly Parkinson’s Progress Report

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 report helps me understand how you’re feeling each week so I can tailor your sessions to your changing needs. Your feedback also helps show general patterns of how Vital Energy Medicine may support people with Parkinson’s. This is not a medical report and does not replace medical care. Please answer honestly to help guide your healing and my continued learning.

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Date(Required)

MM slash DD slash YYYY

🗂️ SECTION 1: Your Recent Participation

In the past week (or since you began working with me), how many of the following have you attended?

(90 min) Private Energy Healing Sessions:(Required)

(60 min) Private Energy Healing Sessions:(Required)

Group Classes:(Required)

Workshop(s):(Required)

Approx. number of home practice sessions:(Required)

✅ SECTION 2 — Physical & Parkinson’s Core Health

👉 Instruction: Please rate how each area is for you right now (1–5) and how it has changed since your last report (1–5).

Energy levels during the day — NOW(Required)

1 (Very poor)

2 (Poor)

3 (Fair)

4 (Good)

5 (Excellent)

Rate how this feels for you right now.

Energy levels during the day-- Change since last report(Required)

1 (Much worse)

2 (A little worse)

3 (About the same)

4 (A little better)

5 (Much better)

Rate how this has changed since your last report.

Muscle comfort & physical strength -- NOW(Required)

1 (Very poor)

2 (Poor)

3 (Fair)

4 (Good)

5 (Excellent)

Rate how this feels for you right now.

Muscle comfort & physical strength -- Change since last report(Required)

1 (Much worse)

2 (A little worse)

3 (About the same)

4 (A little better)

5 ((Much better)

Rate how this has changed since your last report

Balance and postural strength -- NOW(Required)

1 (Very poor)

2 (Poor)

3 (Fair)

4 (Good)

5 (Excellent)

Rate how this feels for you right now

Balance and postural strength -- Change since last report(Required)

1 (Much worse)

2 (A little worse)

3 (About the same)

4 (A little better)

5 (Much better)

Rate how this has changed since your last report

Sleep quality -- NOW(Required)

1 (Very poor)

2 (Poor)

3 (Fair)

4 (Good)

5 (Excellent)

Rate how this feels for you right now

Sleep quality -- Change since last report(Required)

1 (Much worse)

2 (A little worse)

3 (About the same)

4 (A little better)

5 (Much better)

Rate how this has changed since your last report

Pain levels -- NOW(Required)

1 (Very severe)

2 (Severe)

3 (Moderate)

4 (Mild)

5 (None)

Rate how this feels for your right now

Pain levels -- Change since last repprt(Required)

1 (Much worse)

2 (A little worse)

3 (About the same)

4 (A little better)

5 (Much better)

Rate how this has changed since your last report

Parkinson’s tremor or shaking -- NOW(Required)

1 (Very severe)

2 (Severe)

3 (Moderate)

4 (Mild)

5 (None)

Rate how this feels for you right now.

Parkinson’s tremor or shaking -- Change since last report(Required)

1 (Much worse)

2 (A little worse)

3 (About the same)

4 (A little better)

5 (Much better)

Rate how this has changed since last report

Slowness of movement -- NOW(Required)

1 (Very severe)

2 (Severe)

3 (Moderate)

4 (Mild)

5 (None)

Rate how this feels for you right now.

Slowness of movement -- Change since last report(Required)

1 (Much worse)

2 (A little worse)

3 (About the same)

4 (A little better)

5 (Much better)

Rate how this has changed since last report

Stiffness or rigidity -- NOW(Required)

1 (Very severe)

2 (Severe)

3 (Moderate)

4 (Mild)

5 (None)

Rate how this feels for you right now.

Stiffness or rigidity -- Change since last report(Required)

1 (Much worse)

2 (A little worse)

3 (About the same)

4 (A little better)

5 (Much better)

Rate how this has changed since last report

✅ SECTION 3 — Mental & Emotional Core Health

Clarity of thought -- NOW(Required)

1 (Very poor)

2 (Poor)

3 (Fair)

4 (Good)

5 (Excellent)

Rate how this feels for you right now.

Clarity of thought -- Change since last report(Required)

1 (Much worse)

2 (A little worse)

3 (About the same)

4 (A little better)

5 (Much better)

Rate how this has changed since last report

Motivation to do things -- NOW(Required)

1 (Very poor)

2 (Poor)

3 (Fair)

4 (Good)

5 (Excellent)

Rate how this feels for you right now.

Motivation to do things -- Change since last report(Required)

1 (Much worse)

2 (A little worse)

3 (About the same)

4 (A little better)

5 (Much better)

Rate how this has changed since last report.

Confidence -- NOW(Required)

1 (Very poor)

2 (Poor)

3 (Fair)

4 (Good)

5 (Excellent)

Rate how this feels for you right now.

Confidence -- Change since last report.(Required)

1 (Much worse)

2 (A little worse)

3 (About the same)

4 (A little better)

5 (Much better)

Rate how this has changed since the last report.

Depression or sadness -- NOW(Required)

1 (Very severe)

2 (Severe)

3 (Moderate)

4 (Mild)

5 (None)

Rate how this feels for you right now.

Depression or sadness -- Changes since last report(Required)

1 (Much worse)

2 (A little worse)

3 (About the same)

4 (A little better)

5 (Much better)

Rate how this has changed since the last report

Anxiety or worry -- NOW(Required)

1 (Very severe)

2 (Severe)

3 (Moderate)

4 (Mild)

5 (None)

Rate how this feels for you right now.

Anxiety or worry -- Changes since last report(Required)

1 (Much worse)

2 (A little worse)

3 (About the same)

4 (A little better)

5 (Much better)

Rate how this has changed since the last report.

Hopefulness -- NOW(Required)

1 (Very poor)

2 (Poor)

3 (Fair)

4 (Good)

5 (Excellent)

Rate how this feels for you right now.

Hopefulness -- Changes since last report(Required)

1 (Much worse)

2 (A little worse)

3 (About the same)

4 (A little better)

5 (Much better)

Rate how this has changed since the last report

Enthusiasm & pep in your step -- NOW(Required)

1 (Very poor)

2 (Poor)

3 (Fair)

4 (Good)

5 (Excellent)

Rate how this feels for you right now.

Enthusiasm & pep in your step -- Changes since last report(Required)

1 (Much worse)

2 (A little worse)

3 (About the same)

4 (A little better)

5 (Much better)

Rate how this has changed since your last report

✅ SECTION 4 — Snapshot Only

👉 For supporting details — just current feeling, no trend needed weekly:

Sensory awareness in the body(Required)

1 (Very poor)

2 (Poor)

3 (Fair)

4 (Good)

5 (Excellent)

Digestion and elimination(Required)

1 (Very poor)

2 (Poor)

3 (Fair)

4 (Good)

5 (Excellent)

Voice clarity or vocal strength(Required)

1 (Very poor)

2 (Poor)

3 (Fair)

4 (Good)

5 (Excellent)

Reproductive energy or drive(Required)

1 (Very poor)

2 (Poor)

3 (Fair)

4 (Good)

5 (Excellent)

Overall quality of life(Required)

1 (Very poor)

2 (Poor)

3 (Fair)

4 (Good)

5 (Excellent)

✅ SECTION 5 — Reflections

How would you describe how you feel overall right now?

If you’ve felt more pep, spark, motivation, or strength lately, when did you notice it most?

What positive shifts or improvements have you noticed since your last check-in?

Are there any areas that still feel stuck or need extra support?

Is there anything you’d like Brendan to know or focus on in your next session?

Privacy & Sharing
I use your answers to personalize your sessions, track your progress, and, with your permission, share general, anonymous insights to educate, inspire, and help others — including possible research partners in the future. I will never share your name or contact details without your clear 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

Comments

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