Ginas Higher-Self Assessment

THE HIGHER-SELF ASSESSMENT

Find out what's stopping you from unlocking your full potential. Created by Gina Scafoglio
Name*

First NameLast Name
What are your top priorities in life right now?*
What are some things you love about yourself?*
What's stops you from showing up as the best version of yourself (your higher-self) on a daily basis?*
What other obstacles are you facing in life right now?*
How do you typically respond when you're faced with stress or overwhelm?*
Do you feel connected to your intuition when making decisions? Why or why not?*
What habits or routines do you currently have in place to support your well-being?*
How often do you feel present and grounded in your daily life?*
What would your life look and feel like if you unlocked your full potential?*
Please describe a typical day of eating and exercise for you.*
What is one thing you’re ready to let go of to move forward?*
Upload a photo of your current physique if you have body goals!

Optional
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What is your age, height, & weight?*
Email*
example@example.com
Please provide your phone number. I will contact you via TEXT! Please be sure to provide the correct phone number*
International Applicants: Please provide mobile number in the last box of this application.
What is your Instagram handle?*
Or other social media.
I will contact you via text to review your Higher-Self Assessment. Please select all statements that feel aligned with you and where you currently are

I filled this out out of curiosity but I’m open to learning more.I am actively seeking guidance and support.I am interested in a 1:1 mentorship with Gina Scafoglio.I know I need this work and want to discuss the next steps.I’m ready to invest in myself and take action.
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THE HIGHER-SELF ASSESSMENT