QUESTIONARE OF FIRST STEP INSTRUCTIONS OF STEP BY STEP HEALTH IMPROVEMENT PLAN

Name of the student

Registration

Date of commencement of observances:

Date of answering the questionnaire

Set timings for rising up and sleep

Whether any attempt has been made to set timings for sleep and getting up?

Yes

No

If yes, Old timings for sleep and getting up

New timings set , after reading the instructions

Quality of sleep

Before

After

Whether any problem has been encountered in getting sleep?

Yes

No

What techniques have been followed to get rid of them?

If yes,What they are?

How is your feeling when you get up?

Regulate water drinking

Whether you were in the habit of taking anything like bed tea or water etc. as you rise up?

Yes

No

What are you taking now as you get up after reading the instructions?

What were your general habits of taking water previously and how many glasses of water you were habituated to drink daily?

What new habits have been cultivated to regulate water drinking and how many glasses of water you take now?

What are your observations and feelings in regard to bowel movement, hunger etc. after adapting to new habits to regulate water drinking?

Simplifying your Diet and Come Closer to Natural Diet

What was your diet pattern previously? State along with timings for breakfast

For lunch

For dinner

food or drink habituated to, in between hours.

What changes have been made in it?

What are your observations after adopting new diet pattern in regard to

Diseases suffering from, if any, like acidity, constipation, gas problem etc.

General feelings:

Have you tried to find out what health harming food items are part of your dietary? Mention what they are.

What you plan to do with them

Give Physiological Rest to Body by Observing Fasting Periodically

Whether you have ever observed fasting prior to joining this course

Yes

No

If yes, state Purpose

Days

What you took during fasting?

Feeling during and after fasting.

Whether you have observed fast after reading the instructions?

Yes

No

If yes, state Days

Feelings during and after fasting

Whether you rested during fasting?

Yes

No

Do you feel that occasional fasting may suit in your personal health improvement plan? State why?

Whether any one of your family members or friends has been observing fasting occasionally or has any experience of short or long fasting?

Yes

No

Have you ever enquired their experiences of fasting?

Yes

No

Have you ever seen or heard of any such institution where fasting has been prescribed for therapeutic purposes?

Yes

No

Have you ever read any book on fasting?

Yes

No

Don’t be in Hurry

Are you one of those who are always in hurry?

Yes

No

What new habits you have cultivated to avoid hurry?

Whether instruction No.5 (b) i.e to sit or stand quiet for 2-3 minutes before starting for office, has been observed

Yes

No

If yes, what are your feelings about it?

Know the Disturbing Factors and Face them

Is there any residual problem which has been disturbing you and you feel that our guidance /assistance is required? If yes, please intimate to us in the following proforma:-

The problem :

In your Opinion :

What have :

what you

What should be done

expect us

to solve the problem

Be happy

Are you happy?

Yes

No

If Not,Why?

What do you feel is the best way to keep you happy?

Have you ever tried to observe the secrets of a happy person?

Yes

No

General : Please write your assessment and over all feeling about the effects of the seven instructions you have observed.

Questionare of First Step Instructions

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