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* 1. To what extent do you feel you are DOING WHAT YOU LOVE, LIVING YOUR LIFE'S PURPOSE and EXPRESSING YOUR FULL POTENTIAL?

(choose the answers that best describe you)

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* 2. Which of the following areas are bringing you the most frustration and anxiety or which, IF TRANSFORMED, WOULD HAVE THE MOST POSITIVE IMPACT ON YOUR QUALITY OF LIFE (for your physical, emotional, mental or spiritual well-being)?

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* 3. If your life in the following areas continues in the direction, and at the current pace, which it is currently going in, how happy and fulfilled would you expect to be in 15 or 20 years' time?

(choose the answer that comes closest to expressing what you think you might feel)

  Ecstatically happy Satisfied Somewhat disappointed Depressed
HEALTH
FAMILY relationships
ROMANTIC relationships
FRIENDSHIPS
CAREER development
LIVING YOUR LIFE'S PURPOSE
PROSPERITY and ABUNDANCE
CREATIVE fulfilment
SOCIAL/ COMMUNITY PARTICIPATION
COMMUNITY-BUILDING

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* 4. IF YOU HAD THE RESOURCES YOU NEED, AND KNEW FOR CERTAIN THAT YOU COULD NOT FAIL, WHAT WOULD YOU NOW FOCUS YOUR TIME, ENERGY AND OTHER RESOURCES ON ACHIEVING ABOVE ALL ELSE? (it can be a short, medium, or long-term goal)

(please answer briefly here, but feel free to journal about this in more detail and to share this later by email, or during a consultation/coaching session, if you have one scheduled)

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* 5. What are the FEELINGS or THOUGHTS that come to you WHEN YOU IMAGINE ACHIEVING YOUR MOST AMBITIOUS AND INSPIRING GOALS?

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* 6. Think of 3 things that are FUNDAMENTALLY IMPORTANT FOR YOU TO ACHIEVE IN THE NEXT 5-15 YEARS for you to feel really good about yourself, and write them below:

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* 7. Think of the things that are FUNDAMENTALLY IMPORTANT FOR YOU TO ACHIEVE for you to feel really good about yourself, and write them below:

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* 8. Which, if any, of these issues, habits, or activities do you feel are HOLDING YOU BACK from feeling FULLY MOTIVATED, EMPOWERED and ENTHUSIASTIC about where you are CURRENTLY HEADING in your life?

(choose all that apply)

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* 9. To what extent would it be valuable for you to have ongoing support to help you get clear, and stay clear, about your goals and your obstacles, and to create support structures, to leave behind patterns of frustration and start consistently celebrating progress and success in the areas that are important for you?

(choose the answers that best describe you)

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* 10. Please leave your contact details

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