Depression & Anxiety Questionnaire

Thank you in advance for taking the time to complete my Depression & Anxiety Questionnaire. Once your Questionnaire is completed I will personally email you my thoughts – please give me a few days to do this.

I understand first hand how Depression and Anxiety can rob you of the life your heart craves – I have experienced both several times throughout my life. Know there is hope.

Once you complete this Questionnaire you will be able to download a Complimentary PDF copy of my book Understanding The Jesus Code. I wrote it so God’s children can come to better understand, and follow, the path he has for them – a path that leads into true happiness and joy.

1 Peter 5:10 – The God of all grace who called you to his eternal glory through Christ [Jesus] will himself restore, confirm, strengthen, and establish you after you have suffered a little. (NABRE)

Carolyn Berghuis, MS, ND, CTN

Client Intake Form

Thank you for taking the me to complete my Intake Forms. Enjoy the journey of self discovery. Most clients find that it takes them 45 minutes or so to complete my Intake Forms.

When we work together I will address the needs of your whole person; body, heart, and soul. Given this, my Intake Forms are designed to direct us to the places that need a little tender loving care – wherever they may be. Once you have provided some basic personal information the forms will begin by asking questions about the piece of you that yields the greatest power in your ability to reach wholeness – your spiritual well-being. After that, we will look into the subconscious files that lead to health or disease – your heart. The last section contains questions about your physical health – your body.

During each section you will be a offered plenty of space to share your story, please take advantage of this. The clearer picture I have of you the easier it will be for us to uncover the obstacles holding you back from all the health, happiness, and wholeness you desire.

Carolyn Berghuis, MS, ND, CTN



I attended with a friend, who had made a long distance connection with Dr. Carolyn. The whole experience not only took me by surprise, it left me a bit dumbfounded! Although I had taken many steps towards healing previously, LIVE allowed further release…

Korinne, Retreat Attendee

This transformational retreat literally left me speechless and it took many days to process the incredible healing that took place during this 2 day retreat. Optimal physical health can never be reached if you are emotionally unhealthy. This retreat helps you honor second …

Anne, Retreat Attendee


Carmel, IN 46032 USA

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