8/17/2019 Chios Patient Chart

1/1

Patient: ___________________________________________ Date: ________________ 

 Notes: ____________________________________________________________________________________

  ________________________________________________________________________________________________________________

X = Radiatory Needed X = Blocked ChakraL = Leak / T = Tear 

EI = Energy Impurities

Special Needs/

Diseased Areas

Aura Charging Needed 

Correction of Energy Flow Needed 

Grounding Needed 

Spine Cleaning Needed Other Needed _________________ 

   C   h  a  r  g   i  n

  g   &    R

  e   b  a   l  a  n  c   i  n  g

X = Charging Needed 

1

2

3

4

5

6

7

17

6 54 3

2

1

2

3

4

5

6

7

2nd Layer  3rd Layer 4th Layer   5th Layer 6th Layer   7th Layer 

= Rebalancing Up Needed  = Rebalancing Down Needed 

Indicate Pattern of Imbalance