*1.What’s your name?(Required.)

*2.What’s your email?(Required.)

3.What’s your Phone Number?

*4.What area of your life do you most want to focus on?(Required.)

My mindset / beliefs

Relationship with others

My dreams

Romantic / Dating relationships

Relationship with God

Other (please specify)

*5.Which of the following best describes what gets in your way?(Required.)

I don't believe I can do it / it’s not possible

Not having enough time / energy to get things done

Pain from past / present rejection

Not able to create & keep boundaries

I feel unmotivated / unworthy / not confident

I don’t know where to start

*6.How do you feel about your progress on your current goals?(Required.)

I’m on track but could use support.

I’m nowhere near on target.

I don’t even have goals lol

I’m good, thanks.

*7.Which best describes your willingness to commit to having a FULFILLED life?(Required.)

Very willing: I’m ready to do whatever it takes.

Pretty willing: I know it’s worth it, I still have feelings of insecurity and self-doubt.

Somewhat willing: I hold judgments about whether it will make a difference, but I know I need the support.

Not willing at all: My fear of change is bigger than my desire to grow. 

8.Is there anything I haven’t asked you in the survey that you would like to share?