Peace List

Instructions for your meridian tapping first session:

Your answers to this form will help me to know a little about you before we start. This is just a starting point.

Before we meet it’s important for you to have a good idea about your goals for the session.

Instructions: Please just write some basic details for each section, including the age of the event, a title (think movie title) and how the incident made you feel.

Example: Age 6, Teacher taped my mouth shut: fear, shame, guilt, violated, etc. (Note whatever the feelings really were.)

Name
First Last
Email
WHAT WOULD YOU LIKE TO ACHIEVE IN THIS SESSION? In just a few words, what issue are you trying to resolve?
i.e. I want to be less depressed.
WHAT ARE THE MAJOR STRESSORS IN YOUR LIFE?
WHAT DO YOU DO TO RELAX? WHAT DO YOU DO TO HAVE FUN?
Make Your Peace List
Include everything you need to make peace with in your life. Every bad thing you have experienced witnessed or were told stories about. Anything you know had some negative emotional impact at the time, even if it doesn’t bother you now. You don’t need to write the story, just list a title for each memory, plus the emotions you felt during the experience. Example: Age 6, Teacher taped my mouth shut: fear, shame, guilt, violated, etc. (Note whatever the feelings really were.)
1. Start at Birth, before birth, what’s going on with parents, the stories you were told.
2. How siblings and family members felt about you, how they treated you.
3. First experiences. List what you can remember or the stories you were told.
4. Any sexual abuse. Your first sexual experience (if there are negative emotions around it).
5. Emotional or physical abuse or traumas.
6. School experiences, issues with teachers, classmates, etc.
7. Major moves, changing schools.
8. Deaths of pets, pet injuries, losses.
9. Any romantic relationships, especially first boyfriend/girlfriend.
10. Pivotal points in life with parents, siblings, bosses, co-workers, whoever.
11. Divorce, relationship breakups, broken friendships.
12. Deaths, grief and loss, loss of job, loss of health.
13. All hurts, anything you felt bad about when it happened
14. All major medical illnesses, chronic illnesses, other medical problems.
15. Accidents and injuries.
16. Fears, phobias, list each experience to support the fear.

All sessions are confidential. I look forward to meeting with you. Remember, Highlight anything you want to discuss. Do your best and do not stress. We will begin with your most significant issues.

Rita Duncan | (253) 973-0338 | Contact Destination Health today!

Peace List

Make Your Peace List