Your Personalized Power Pack - Over 18

Your Personalized Power Pack

Reclaim Your Personal Power
Take 2 minutes to answer the questions below and get started with practical tools to build your future success! Be honest with yourself in your responses. Remember, we're all a progressive work of art.

Must be 18 years or older to participate.
Your name*

First NameLast Name
Email*
example@example.com
Date of Birth*

How satisfied are you with...*

	Very Satisfied	Satisfied	Neutral	Unsatisfied	Very Unsatisfied
Your self-care practices
Your 'me' time
Your home life
Your work life
Your love life
Your sex life (this plays a huge part in our overall well-being)
Your eating habits
Life, overall

How likely are you to...*

	Very Unlikely	Unlikely	Somewhat Likely	Likely	Very Likely
Be consistent until you reach your goals
Receive constructive criticism
Invest time in yourself [even if it's a sacrifice]
Be open to change
Be willing to develop and practice new habits
Take risks
Fully commit to your own success

Which one of these is more of a priority to you?*

A successful careerFulfilling a personal dreamRasing childrenCultivating familyStarting a businessTime aloneMore time for hobbiesBeing in a love relationship
What is your most productive and progressive habit?*
What is your most counter-productive and limiting habit?*
What is the ONE goal you'd like for us to focus on and create tools around?*
Should be Empty: