Self Reflection

You know that feeling when your mind just won’t quiet down, and your body feels tense all over?

It’s like you’re constantly on edge, and no amount of “relaxation time” seems to make it better. Let’s lean into it. Give yourself permission to answer the following questions honestly. That way, we can dive into what is holding you back from living the best life possible for you.

On a scale of 1-10, how would you rate your current stress levels?(Required)

1 is a low stress level, 10 is a high stress level

Please explain what contributes most to your stress rating.(Required)

(e.g. Family pressure and work demands, Work/Career: %, Relationships: %, Financial: %, Health: %, etc.)

How does stress typically manifest in your body?(Required)

(e.g., headaches, muscle tension, sleep issues)

What’s your biggest challenge that you’re facing day-to-day?(Required)

How effective are you at managing your stress on a scale 1-10?(Required)

1 is not effective, 10 is very effective

What areas of your life (e.g. decision making, relationships, work performance, health choices) do you feel are suffering the most due to stress, anxiety or overwhelm?(Required)

How would you describe your energy levels throughout a typical day, 1-10?(Required)

1 is a low energy level, 10 is a high energy level

When you feel stressed, what is your default coping mechanism?(Required)

How good is your sleep on a scale from 1-10?(Required)

1 indicates your sleep isn't good at all, 10 indicates your sleep is very good

How would you rate your mental clarity on a scale from 1-10?(Required)

1 is a low mental clarity, 10 is a high mental clarity

When was the last time you felt truly relaxed, and what were you doing?(Required)

What specific support or tools do you believe would help you manage stress better?(Required)

Name(Required)

First Last

Email(Required)

Phone(Required)