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Questionare of Second Step Instructions
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Name of the student:
Student Registration No.
Date of commencement of observances:
Date of answering the questionnaire:
Personal Details
Age
Height
Occupation
weight
Pulse
B.P
Eye Sight
Health Status (Good/Poor/Fair)
Whether suffering from
B.P (High & Low)
Diabetes
Asthma
Arthritis
Any other disease
Food habits (Vegetarian/Non-vegetarian)
Vegetarian
Non -Vegetarian
Any other fact not covered above which the student wants to mention specially
Find time for exercise
What timings have been set for exercises?
What exercises are being done?
How much time is devoted daily for exercises?
Whether the Yogasanas advised in the Health Improvement Plan have been tried?
Yes
No
If yes, their sequence and time devoted to perform them.
Whether you enjoy massage and do regularly?
Yes
No
If yes, mention how many times you go for massage per week or per month.
Whether you go for walking or jogging?
Yes
No
If yes, mention timings.
Don’t Abuse Your Energies
What, do you feel, are the excesses and abuses you have been committing so far?
Yes
No
What have been done to correct them?
Do you feel energetic after rest and sleep?
Yes
No
If No, whether you tried to find out what is wrong.
Don’t be One Sided
What do you do to nourish your
Physical plane?
Mental plane?
Moral and Social Planes?
Spiritual plane?
Whether you tried to spend some time alone as suggested in instruction 2(iv)?
If yes, mention your feelings.
Be Aware About Whatever You Do
Can you distinguish between doing a thing mechanically and consciously?
Yes
No
Have you experimented about remaining aware about whatever you do?
Yes
No
Have you any health harming habit that you intend to get rid of through this technique of consciousness?
Yes
No
Please write your assessment and over all feeling about effects of five instructions you have observed.
Submit Form
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