Self-Worth Survey Question Title * 1. What’s your name? Question Title * 2. What’s your email? Question Title * 3. What’s your Phone Number? Question Title * 4. What area of your life do you most want to focus on? My mindset / beliefs Relationship with others My dreams Romantic / Dating relationships Relationship with God Other (please specify) Question Title * 5. Which of the following best describes what gets in your way? 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 Question Title * 6. How do you feel about your progress on your current goals? 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. Question Title * 7. Which best describes your willingness to commit to having a FULFILLED life? 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. Question Title * 8. Is there anything I haven’t asked you in the survey that you would like to share? Done