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VIP (Vision, Inspiration & Preparation) Life Mentoring Program

1.How would you rate the current state of your life overall?(Required.)
Very Satisfying
Satisfying
Neutral
Unsatisfying
Extremely Unsatisfying
N/A
Scale
2.Have you taken steps to change the current state of your life?(Required.)
Yes
Yes, but not consistently
Neutral
I want to but I don't know where to 
No
N/A
Scale
3.If you answered yes or yes, but not consistently please elaborate.
4.How many areas of your life do you feel you need to see movement?(Required.)
One area
Two areas
Three areas
Four areas
Five or more areas
N/A
Scale
5.How motivated are you to make a change in your life?(Required.)
I'm extremely motivated
I'm motivated
Neutral
I'm inconsistently motivated
I'm unmotivated
N/A
Scale
6.How much do you believe that you can achieve the change you wish see?(Required.)
I believe!
I know I can do it but I'm scared.
Neutral
I'm skeptical.
I feel hopeless.
N/A
Scale
7.How much time do you have to invest every week for this program?(Required.)
7 hours a week.
6 hours a week.
I'm unsure
5 hours a week.
4 or less hours a week
N/A
Scale
8.How frequently do you receive spa treatments such as massages, facials, body wraps? Spa treatments are not hair and nails/pedicures. (Required.)
Weekly
Bi-weekly
Monthly
I don't get spa treatments but I get my hair and nails/pedicure
Less than every 3 months
N/A, I have never received a spa treatment
Scale
9.How frequently do you practice yoga?(Required.)
Weekly
Bi-weekly
Monthly
I don't practice yoga but I workout/gym/walk
It's been over 6 months
N/A, I have never practice yoga or it's been over a year
Scale
10.Do you like to read?(Required.)
I love to read!
I don't mind reading
Neutral
I don't like to read, but I will.
I don't like read.
N/A
Scale
11.Do you have a faith, pray or meditate?(Required.)
Yes, I faithfully practice a religion
Yes, I have a faith
Yes, I am spiritual. I pray and meditate regularly.
It's complicated
I'm an atheist. 
N/A
Scale
12.Do you have school age children?(Required.)
No. I do not have any children or I have an adult child/children
Yes, I have one school age child.
Yes, I have two school age children.
Yes, I have 3 school age children.
Yes, I have 4 or more school age children.
N/A
Scale
13.Do you have a supportive partner or a support system (friends, parents, in-laws, etc)(Required.)
I have a supportive partner and a strong support system.
I have a supportive partner or a strong support system.
I have a partner and/or support system. I am not sure how supportive they may be.
I know my partner and/or support system will not be supportive.
I do not have a partner or a support system
N/A
Scale
14.How much are you willing to invest to change your life/situation?(Required.)
I am willing to invest whatever dollar amount it takes.
I am willing to invest.
I have a set budget.
I don't have a lot to invest but I need a change.
I don't have anything to invest.
N/A
Scale