How do you usually feel in your body? *

Strong, grounded, and present

Tense but manageable

Disconnected or checked out

Heavy, inflamed, or exhausted

When you have quiet time alone, what comes up? *

Peace and gratitude

A long to-do list

Emptiness or emotional weight

I avoid stillness altogether

What part of your life feels most out of alignment? *

My schedule and pace

My connection to myself

My emotional wellbeing

My identity and direction

How often do you do something purely for yourself—without guilt? *

Daily

Once or twice a week

Occasionally, but I forget

I honestly don’t remember the last time

How do you feel when you look in the mirror? *

Proud of who I see

Meh. I don’t really think about it

A stranger. I barely recognize her

I avoid looking if I can

Deep down, what are you most afraid of admitting? *

That I need more rest than I allow

That I’ve drifted away from myself

That I’m numb and not sure why

That I don’t feel like "me" anymore

How often do you feel joy or aliveness in your day? *

Daily, even in small moments

Sometimes, but not often

Rarely—I feel mostly flat

Never. I’m just trying to get through

Which statement hits closest? *

"I feel connected to who I’m becoming"

"I know I'm meant for more, but don't know how to access it"

"I feel like I lost myself along the way"

"I don't feel much of anything anymore"

What is your relationship with your body today? *

I trust and care for her

I try, but it's inconsistent

I feel detached and sometimes resentful

I feel shame, disconnection, or apathy

Full Name *

Phone *

Email *

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