Sound Therapy Feedback Form

After using your sounds provided to you from Elaine Thompson for at least three weeks, please fill out the form below, as it is vital to Elaine’s process. This information provides data for Elaine to track how effective her therapy has been, and if there are any places where improvement is needed regarding the next stage of your sound therapy.

If you are a few weeks in to your therapy, and your results are not visible, then your sound may need altering. This can be done either by contacting Elaine for a retest, or you can organise to send your box back for edits based on your previous assessment.

Please answer each question with as much detail as possible.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Today's Date

Form completed on this day

YYYY

How many hours a day have you been listening to your sound?

How have you been listening to your sound?

For example, using a headset or through speakers

Emotional Status

Have you noticed a change in your attitude towards life?

Please describe any changes you've noticed

Is your outlook more positive since listening to your sounds? In what way?

Are you feeling more cheerful?

Have you felt more peaceful in yourself?

Have you noticed an increase in energy or motivation since listening to your sounds?

If you experience impaired movement: have you tried doing anything that you cannot normally do since listening to your sounds?

Have you noticed a change in your sleep quality?

Have you experienced a change in your general emotional state?

For example, are you feeling more sensitive, more positive, more calm

Can you remember any meaningful dreams you've experienced since listening to your sounds?

Have you found yourself remembering past events more frequently?

Especially memories of trauma or stressful situations

Have you noticed a change in your ability to think?

For example, are you able to think more clearly?

Describe any positive things that you have done since listening to your sounds

For example, finishing a project, reaching out to a loved one

Have those around you noticed a change in you?

On a scale of 1-10 (1 being not good, 10 being wonderful) how are you feeling about yourself currently?

Regarding your thought patterns: is the balance of your thinking more positive or negative?

Have you noticed a shift since listening to your sounds?

Physical Status

Have you noticed a particular part of the body where you feel the sound when you listen to it?

This might not be a physical feeling, like a tingling, but perhaps an awareness of the sound centering somewhere in the body

Have any physical changes related to your problem occurred in recent weeks?

If applicable

Have you noticed a change in pain levels?

If applicable

Are you more mobile than you were before you started listening to your sounds?

If applicable

If your problem concerns immobility or paralysis, please list any symptoms that have seen improvement or change, no matter how small.

If your problem concerns body tremors, please detail any changes no matter how small.

Have your mental faculties improved at all?

Please describe any other improvements you've noticed since listening to your sounds

How do your sounds feel?

For example, is the volume suitable?

If you are taking any medication, have you managed to lessen your dosage since listening to your sounds?

Have you informed your doctor about your sound therapy? What was their reaction?

How do you feel after each time you listen to your sound?

How do you feel when the sound is turned off?

Please describe what you think has changed or improved since you started listening to your sounds