My Reality Check | mindmyself.net

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About youPlease include your details if you are booking a call or appointment.
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Your email addressOPTIONAL: We will email you your responses for you to refer &/or keep
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Your Phone NumberOPTIONAL: Please enter your Country Code, then Mobile Phone or Cell Number
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How SATISFIED are you with your LIFE at present?* This field is required.Please Rate your happiness from 1 (completely unhappy) to 10 (completely happy)
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Completely Dissatisfied
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What do you LIKE about YOUR LIFE?* This field is required.(100 character max per item / issue)
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What do you LIKE about YOUR SELF?* This field is required.(100 character max per item / issue)
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What do you want to CHANGE?* This field is required.(100 character max per item / issue)
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In your life, what would you like to GAIN / HAVE MORE OF?* This field is required.(100 character max per item / issue)
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In your life, what would you like to REDUCE / ELIMINATE?* This field is required.(100 character max per item / issue)
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How SATISFIED are you with your SELF at present?* This field is required.Rate your happiness from 1 (completely unhappy) to 10 (completely happy)
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Completely Dissatisfied
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What are the most important things you would like to change* This field is required.Rank in order of your priority for change
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For you, how IMPORTANT is it to make these CHANGES (above)?* This field is required.Rate the importance of changing from 1 (absolutely unimportant) to 10 (absolutely essential)
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DESCRIBE yourself, and your life as you see them NOW.
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DESCRIBE yourself, and your life as you WANT them to be.
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What are 3 short-term ACTIONS you can take to start making these changes?* This field is required.(100 character max per item / issue, add more ACTIONS if you like!)
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Many people struggle to follow-through on commitments to themselves, even if that would enable greater happiness, health and fulfilment. Please indicate which of these statements best describe how you feel?Please select those that BEST describe how you feel
I know I'll achieve my Goals by myself
I'm very likely to achieve my Goals by myself
I'm more likely to achieve my Goals with support
I'm unlikely to reach my Goals without support
I'd prefer not to reach my Goals than get support
I don't believe in asking other people for support
I don't believe in wanting more, or pursuing Goals
Other
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Would you like to book a short call to talk about making these changes?* This field is required.
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