The Mindful Survey
Please take a few minutes to tell us more about you and your preferences which will allow us to tailor workshops based on your needs
What is your gender?
Female
Male
Non-binary
Prefer not to answer
What is your age range?
0-17
18-24
25-34
35-44
45-54
55-64
65+
What is your employment status?
Full-time
Entrepreneur
Part-time
Casual
Prefer Not to Answer
Unemployed
Other
What is the highest level of education you have completed?
Less than high school
High school
Some college / University
College diploma / Certificate
Undergraduate degree
Masters / Graduate degree
Doctorate
Prefer not to answer
Other
What is your fullfilment status?
Very fullfiled
Not happy at all
I know myself enough
I feel like I don't know myself
I am quite happy with my achievents
I need guidance
Not so happy with my achievements
Prefer not to answer
How often do you exercise?
Not All Often
1
2
3
4
5
6
7
8
9
Extremely Often
10
1 is Not All Often, 10 is Extremely Often
How often do you meditate?
Not All Often
1
2
3
4
5
6
7
8
9
Extremely Often
10
1 is Not All Often, 10 is Extremely Often
How often do you find yourself enjoying the present moment?
Not All Often
1
2
3
4
5
6
7
8
9
Extremely Often
10
1 is Not All Often, 10 is Extremely Often
How often do you find yourself fulfiled with your carreer path or purpose?
Not All Often
1
2
3
4
5
6
7
8
9
Extremely Often
10
1 is Not All Often, 10 is Extremely Often
When did you last meditate?
Less than a 1 month ago
Between 1 and 6 months ago
Between 6 months and 1 year ago
More than 1 year ago
I do not remember
Which of the followings would describe your purpose to practice mindfulnes as a tool to improve your wellness?
Mental clarity
Release stress
Let go of tension
Clear your mind and thoughts
Connect with the Divine
Other
Do you believe in the power of your unconscious mind?
Deeply believe
Somewhat believe
I know nothing about it
I don't believe it
Other
How often would you like to attend to your meditation class?
Once per month
Twice per month
Every single week
Once every three months
Which of the followings would influence your decision to assit to one of our transformational classes?
Price
Quality
Value
Time
Other
Please complete the Cognitive and Affective Mindfulness Scale
Rate from 1 to 4 (1=Rarely; 2=Sometimes; 3=Often; 4 Always)
It is easy for me to concentrate on what I am doing.
1
2
3
4
I can tolerate emotional pain.
1
2
3
4
I can accept things I cannot change.
1
2
3
4
I can usually describe how I feel at the moment inconsiderable detail.
1
2
3
4
I am easily distracted.
1
2
3
4
It’s easy for me to keep track of my thoughts andfeelings.
1
2
3
4
I try to notice my thoughts without judging them.
1
2
3
4
I am able to accept the thoughts and feelings I have.
1
2
3
4
I am able to focus on the present moment.
1
2
3
4
I am able to pay close attention to one thing for a longperiod of time.
1
2
3
4
What is one limiting belief that is constantly chansing your mind and you would like to get rid of it?
I am not enough
I am not worthy
I am not capable
I am not worthy of love/success/money
I do not love myself
I do not accept myself
I can't have what I want
Would you like to receive a complementary consultation to understand where are you at and gain clarity in your path in life?
100% READY
Count me in
No, thanks
How much are you willing to invest in your personal development?
$ 10.000 +
$ 5.000+
$ 2.500+
$ 1.000+
$ 500+
Other
Please share your email address
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Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
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