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Full Reset Questionnaire
(5 minutes)
32
Questions
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1
If there was ONE BIG CHANGE that you wanted to make in your life, what would it be? What is the biggest challenge, frustration or problem that's getting in your way of making that change? (please be as specific as possible)
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2
Name
First Name
Last Name
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Email
*
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example@example.com
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Instagram Handle
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I am currently in
(city)
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,
(country)
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.
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6
Whatsapp Phone Number
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Area Code
Phone Number
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7
Give yourself a score in these 5 areas
1=Not at all; 10=100%
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Clarity - I feel that I am clear about who I am, my purpose, and the direction I want to go in life
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Clarity - I feel that I am clear about who I am, my purpose, and the direction I want to go in life
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8
Physical Body
1=Not at all; 10=100%
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Biology - I have enough mental and physical energy needed to accomplish everything I set out to accomplish on a consistent basis
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Biology - I have enough mental and physical energy needed to accomplish everything I set out to accomplish on a consistent basis
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9
Leadership
1=Not at all; 10=100%
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Leadership - I step up for myself and others in uncomfortable situations and hold myself accountable
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Leadership - I step up for myself and others in uncomfortable situations and hold myself accountable
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10
Efficiency
1=Not at all; 10=100%
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Efficiency - I am efficient, consistently focused and I am good at minimizing distractions and maintaining priorities.
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Efficiency - I am efficient, consistently focused and I am good at minimizing distractions and maintaining priorities.
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11
Mindset
1=Not at all; 10=100%
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Mindset - I feel that I am in a good place mentally (my self-talk, self-perception)
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Mindset - I feel that I am in a good place mentally (my self-talk, self-perception)
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12
What do you do for a living, and why did you choose that path?
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13
What is your monthly income?
$1000 to $3000
$3000 to $5000
$5000 to $7500
$7500 to $10,000
$10,000 to $15,000
$20,000 or above
I'm currently unemployed
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14
What is your desired monthly income?
$3000 - $5000
$5000 to $10,000
$10,000 to $15,000
$20,000 to $30,000
$50,000 a month
$100,000 a month+
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15
Money
1=Not at all; 10=100%
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Finances - I am ahead of where I expected to be at this point of my life
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Finances - I am ahead of where I expected to be at this point of my life
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16
What's your current relationship to money and spirituality?
I feel disconnected to both and that needs to change
I know they are connected but I don't know how to link them
I'm doing well, but I could do better
I am pretty much Lakshmi (the Hindu goddess of wealth and abundance)
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17
What are your top 3 goals that you are after right now?
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18
What major stressors or challenges are getting in your way right now?
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19
When do you feel like your most successful and content-self, what makes you feel that way?
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20
What would your ideal life look like if you could make it happen immediately?
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21
What has prevented you from having that ideal life?
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22
Evaluate yourself in these areas
1=Not at all; 10=100%
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My relationships - I'm in a fulfilling relationship or ready to be in one
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My relationships - I'm in a fulfilling relationship or ready to be in one
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23
Health
1=Not at all; 10=100%
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My overall health - I sleep well, manage stress effectively, eat well, exercise and take care of my physical environment
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My overall health - I sleep well, manage stress effectively, eat well, exercise and take care of my physical environment
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24
Lifestyle
1=Not at all; 10=100%
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My hobbies - I have activities outside of my work that challenge me
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My hobbies - I have activities outside of my work that challenge me
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25
Loved ones
1=Not at all; 10=100%
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Family and friends - I keep developing deep and loving relationships with people close to me
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Family and friends - I keep developing deep and loving relationships with people close to me
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26
Mission
1=Not at all; 10=100%
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Mission and purpose - I am clear about my role in this world
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Mission and purpose - I am clear about my role in this world
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27
Spirituality
1=Not at all; 10=100%
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Spirituality - I have a spiritual/meditative practice and keep deepening it on a regular basis
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Spirituality - I have a spiritual/meditative practice and keep deepening it on a regular basis
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28
What would happen if you stayed where you're currently at?
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29
How quickly would you want to change it?
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30
How much are you willing to invest in yourself and your future?
*
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prices are in USD
$500 - $1000
$3000 - $7000
$7000 - $10,000
$10,000+
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31
Is there anyone else involved in you making this decision (If so, I recommend having a conversation prior to us having a meeting)
No, just me
Yes, but I will have a conversation prior to our meeting
Other
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32
How did you find me?
*
This field is required.
IG - ink_pray_love
YogiLab
Youtube
Google
Podcasts
Bali circles or my businesses there
Vancouver circles or my businesses there
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