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3 Post-Class Feedback Form
This form will be filled out after every class.
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* Indicates required question
Email
*
Your email
1. Name
*
Your answer
2. Date of Birth (DD/MM/YYYY) For example, January 3, 2005 = (03/01/2005)
*
Your answer
3. How would you rate your physical tension?
*
No Tension
0
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8
9
Significant Tension
4. How would you rate your mental tension?
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No Tension
0
1
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5
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8
9
Significant Tension
5. How would you rate your anxiety level?
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No Anxiety
0
1
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5
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8
9
Significant Anxiety
6. Does your mind feel sharp and focused?
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No Focus
0
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3
4
5
6
7
8
9
Significant Focus
7. Would you like to share anything else you notice about your physcial, mental, or psychological state since beginning today's class?
Your answer
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