Name *

First Name

Last Name

Do you wonder how to find balance in your life? *

Yes

No

Are you seeking change, but are afraid or nervous? *

Yes

No

Do you struggle with negative emotions & want to break free? *

Yes

No

Do you want to build up your daily routine to find balance? *

Yes

No

Are there areas of your life that you are not happy with? *

Yes

No

Do you struggle to stay positive on a daily basis? *

Yes

No

Do you struggle connecting to your true self? *

Yes

No

Do you want to be more mindful, but don't know how? *

Yes

No

Are your worries, stresses, fears and doubts cluttering your mind daily? *

Yes

No

Are you wanting forward movement in your life, but are unsure how to get there? *

Yes

No

Do you want guidance and direction, but are unsure where to look? *

Yes

No

Do you question the choices you make in life? *

Yes

No

Do you ever feel like you can't truly be yourself? *

Yes

No

Do you ever feel like you are being squashed and someone is taking your power? *

Yes

No