Heart of Well-Being Personal Audit 2018

Please answer these few questions ...

Congratulations on taking this step towards more happiness and success! I hope we will witness together how this program helps you move consistently forward to joy and success. To get you started on thinking about your life, health, projects and issues, here are ten questions related to your ability to create forward momentum. Your subconscious begins to work as you fill out this form and your answers are the starting point for working together. Take your time...

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* 1. What would you like some help with, if you had a fairy godmother?

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* 2. What causes you stress, or what do you often find yourself worrying about?

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* 3. How often do the following apply to you? (Using a scale from one to five, where 5 = applies always or almost always, and 1 = applies never or almost never)

	5	4	3	2	1
I feel upbeat	I feel upbeat 5	I feel upbeat 4	I feel upbeat 3	I feel upbeat 2	I feel upbeat 1
I feel capable and competent	I feel capable and competent 5	I feel capable and competent 4	I feel capable and competent 3	I feel capable and competent 2	I feel capable and competent 1
My thinking is clear and sharp	My thinking is clear and sharp 5	My thinking is clear and sharp 4	My thinking is clear and sharp 3	My thinking is clear and sharp 2	My thinking is clear and sharp 1
I feel stalled with my business or career	I feel stalled with my business or career 5	I feel stalled with my business or career 4	I feel stalled with my business or career 3	I feel stalled with my business or career 2	I feel stalled with my business or career 1
I feel I am not fulfilling my potential	I feel I am not fulfilling my potential 5	I feel I am not fulfilling my potential 4	I feel I am not fulfilling my potential 3	I feel I am not fulfilling my potential 2	I feel I am not fulfilling my potential 1
I feel dissatisfied with my life just now	I feel dissatisfied with my life just now 5	I feel dissatisfied with my life just now 4	I feel dissatisfied with my life just now 3	I feel dissatisfied with my life just now 2	I feel dissatisfied with my life just now 1

Use this space to tell me more about any of the above....

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* 4. What aspects of your life would you say are going well?

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* 5. What aspects of your life would you say are going less well?

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* 6. To what extent do the following 6 phrases describe you? (Using a scale from one to five where 5 = describes me very well ... though 1 = describes me not at all well)

	5	4	3	2	1
Am focused and moving forward with ease on important projects	Am focused and moving forward with ease on important projects 5	Am focused and moving forward with ease on important projects 4	Am focused and moving forward with ease on important projects 3	Am focused and moving forward with ease on important projects 2	Am focused and moving forward with ease on important projects 1
Become defensive or angry easily and take things to heart	Become defensive or angry easily and take things to heart 5	Become defensive or angry easily and take things to heart 4	Become defensive or angry easily and take things to heart 3	Become defensive or angry easily and take things to heart 2	Become defensive or angry easily and take things to heart 1
Sometimes I just can't make myself do something I know I should	Sometimes I just can't make myself do something I know I should 5	Sometimes I just can't make myself do something I know I should 4	Sometimes I just can't make myself do something I know I should 3	Sometimes I just can't make myself do something I know I should 2	Sometimes I just can't make myself do something I know I should 1
Get derailed by emotion (get upset and have trouble getting back to normal)	Get derailed by emotion (get upset and have trouble getting back to normal) 5	Get derailed by emotion (get upset and have trouble getting back to normal) 4	Get derailed by emotion (get upset and have trouble getting back to normal) 3	Get derailed by emotion (get upset and have trouble getting back to normal) 2	Get derailed by emotion (get upset and have trouble getting back to normal) 1
Procrastinate or miss deadlines	Procrastinate or miss deadlines 5	Procrastinate or miss deadlines 4	Procrastinate or miss deadlines 3	Procrastinate or miss deadlines 2	Procrastinate or miss deadlines 1
Able to work intensely on a project for long periods of time	Able to work intensely on a project for long periods of time 5	Able to work intensely on a project for long periods of time 4	Able to work intensely on a project for long periods of time 3	Able to work intensely on a project for long periods of time 2	Able to work intensely on a project for long periods of time 1

Use this space to tell me more about any of the above....

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* 7. What stands out for you as your biggest accomplishment?

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* 8. What project have you started, or goal you've meant to achieve is your biggest frustration with yourself?

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* 9. What now or in the past have you tried for overcoming issues you identify here? personal or business coaching? hypnosis? energy work? counselling? Please use this space to briefly list or describe current or past help before we meet.

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* 10. Thank you! Two last things: What else I should know before we start? Any further thoughts? And before you submit this form, please initial or provide your name and age.