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Quantum Wellness Challenge
You will receive a free evaluation chart upon completion. Estimated duration 10 min.
20
Questions
START
1
Name
First Name
Last Name
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2
Email
example@example.com
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3
What motivates & energizes me?
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4
How I'm feeling right now.
1 = drained, 10 = Amazeballs
1
2
3
4
5
6
7
8
9
10
Worst
Best
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5
How much joy (physical or emotional) am I feeling?
1 = drained, 10 = Amazeballs
1
2
3
4
5
6
7
8
9
10
Worst
Best
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6
How much pain (physical or emotional) am I feeling?
1 = Amazeballs, 10 = Worst
1
2
3
4
5
6
7
8
9
10
None
Worst
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7
Courage
Do you have the Courage to follow and achieve your Dreams & Passions?
100%
90%
75%
65%
50%
40%
35%
25%
15%
0%
Adaptive
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Row 0, Column 7
Row 0, Column 8
Row 0, Column 9
Bravery
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Row 1, Column 7
Row 1, Column 8
Row 1, Column 9
Perseverance
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
Row 2, Column 7
Row 2, Column 8
Row 2, Column 9
Honesty
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
Row 3, Column 7
Row 3, Column 8
Row 3, Column 9
Zest
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Row 4, Column 6
Row 4, Column 7
Row 4, Column 8
Row 4, Column 9
Confidence
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Row 5, Column 6
Row 5, Column 7
Row 5, Column 8
Row 5, Column 9
Adaptive
Bravery
Perseverance
Honesty
Zest
Confidence
100%
Row 0, Column 0
90%
Row 0, Column 1
75%
Row 0, Column 2
65%
Row 0, Column 3
50%
Row 0, Column 4
40%
Row 0, Column 5
35%
Row 0, Column 6
25%
Row 0, Column 7
15%
Row 0, Column 8
0%
Row 0, Column 9
100%
Row 1, Column 0
90%
Row 1, Column 1
75%
Row 1, Column 2
65%
Row 1, Column 3
50%
Row 1, Column 4
40%
Row 1, Column 5
35%
Row 1, Column 6
25%
Row 1, Column 7
15%
Row 1, Column 8
0%
Row 1, Column 9
100%
Row 2, Column 0
90%
Row 2, Column 1
75%
Row 2, Column 2
65%
Row 2, Column 3
50%
Row 2, Column 4
40%
Row 2, Column 5
35%
Row 2, Column 6
25%
Row 2, Column 7
15%
Row 2, Column 8
0%
Row 2, Column 9
100%
Row 3, Column 0
90%
Row 3, Column 1
75%
Row 3, Column 2
65%
Row 3, Column 3
50%
Row 3, Column 4
40%
Row 3, Column 5
35%
Row 3, Column 6
25%
Row 3, Column 7
15%
Row 3, Column 8
0%
Row 3, Column 9
100%
Row 4, Column 0
90%
Row 4, Column 1
75%
Row 4, Column 2
65%
Row 4, Column 3
50%
Row 4, Column 4
40%
Row 4, Column 5
35%
Row 4, Column 6
25%
Row 4, Column 7
15%
Row 4, Column 8
0%
Row 4, Column 9
100%
Row 5, Column 0
90%
Row 5, Column 1
75%
Row 5, Column 2
65%
Row 5, Column 3
50%
Row 5, Column 4
40%
Row 5, Column 5
35%
Row 5, Column 6
25%
Row 5, Column 7
15%
Row 5, Column 8
0%
Row 5, Column 9
1
of 6
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8
Temperance
Do you have the Temperance to stay on your Path?
100%
90%
75%
65%
50%
40%
35%
25%
15%
0%
Forgiveness
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
Row 0, Column 7
Row 0, Column 8
Row 0, Column 9
Humility
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Row 1, Column 7
Row 1, Column 8
Row 1, Column 9
Prudence
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
Row 2, Column 7
Row 2, Column 8
Row 2, Column 9
Self-regulation
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
Row 3, Column 7
Row 3, Column 8
Row 3, Column 9
Forgiveness
Humility
Prudence
Self-regulation
100%
Row 0, Column 0
90%
Row 0, Column 1
75%
Row 0, Column 2
65%
Row 0, Column 3
50%
Row 0, Column 4
40%
Row 0, Column 5
35%
Row 0, Column 6
25%
Row 0, Column 7
15%
Row 0, Column 8
0%
Row 0, Column 9
100%
Row 1, Column 0
90%
Row 1, Column 1
75%
Row 1, Column 2
65%
Row 1, Column 3
50%
Row 1, Column 4
40%
Row 1, Column 5
35%
Row 1, Column 6
25%
Row 1, Column 7
15%
Row 1, Column 8
0%
Row 1, Column 9
100%
Row 2, Column 0
90%
Row 2, Column 1
75%
Row 2, Column 2
65%
Row 2, Column 3
50%
Row 2, Column 4
40%
Row 2, Column 5
35%
Row 2, Column 6
25%
Row 2, Column 7
15%
Row 2, Column 8
0%
Row 2, Column 9
100%
Row 3, Column 0
90%
Row 3, Column 1
75%
Row 3, Column 2
65%
Row 3, Column 3
50%
Row 3, Column 4
40%
Row 3, Column 5
35%
Row 3, Column 6
25%
Row 3, Column 7
15%
Row 3, Column 8
0%
Row 3, Column 9
1
of 4
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Enter
9
Justice
Do you attain and maintain Justice on your Quest?
100%
90%
75%
65%
50%
40%
35%
25%
15%
0%
Citizenship
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
Row 0, Column 7
Row 0, Column 8
Row 0, Column 9
Discernment
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Row 1, Column 7
Row 1, Column 8
Row 1, Column 9
Fairness
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
Row 2, Column 7
Row 2, Column 8
Row 2, Column 9
Leadership
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
Row 3, Column 7
Row 3, Column 8
Row 3, Column 9
Teamwork
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Row 4, Column 6
Row 4, Column 7
Row 4, Column 8
Row 4, Column 9
Judgment
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Row 5, Column 6
Row 5, Column 7
Row 5, Column 8
Row 5, Column 9
Citizenship
Discernment
Fairness
Leadership
Teamwork
Judgment
100%
Row 0, Column 0
90%
Row 0, Column 1
75%
Row 0, Column 2
65%
Row 0, Column 3
50%
Row 0, Column 4
40%
Row 0, Column 5
35%
Row 0, Column 6
25%
Row 0, Column 7
15%
Row 0, Column 8
0%
Row 0, Column 9
100%
Row 1, Column 0
90%
Row 1, Column 1
75%
Row 1, Column 2
65%
Row 1, Column 3
50%
Row 1, Column 4
40%
Row 1, Column 5
35%
Row 1, Column 6
25%
Row 1, Column 7
15%
Row 1, Column 8
0%
Row 1, Column 9
100%
Row 2, Column 0
90%
Row 2, Column 1
75%
Row 2, Column 2
65%
Row 2, Column 3
50%
Row 2, Column 4
40%
Row 2, Column 5
35%
Row 2, Column 6
25%
Row 2, Column 7
15%
Row 2, Column 8
0%
Row 2, Column 9
100%
Row 3, Column 0
90%
Row 3, Column 1
75%
Row 3, Column 2
65%
Row 3, Column 3
50%
Row 3, Column 4
40%
Row 3, Column 5
35%
Row 3, Column 6
25%
Row 3, Column 7
15%
Row 3, Column 8
0%
Row 3, Column 9
100%
Row 4, Column 0
90%
Row 4, Column 1
75%
Row 4, Column 2
65%
Row 4, Column 3
50%
Row 4, Column 4
40%
Row 4, Column 5
35%
Row 4, Column 6
25%
Row 4, Column 7
15%
Row 4, Column 8
0%
Row 4, Column 9
100%
Row 5, Column 0
90%
Row 5, Column 1
75%
Row 5, Column 2
65%
Row 5, Column 3
50%
Row 5, Column 4
40%
Row 5, Column 5
35%
Row 5, Column 6
25%
Row 5, Column 7
15%
Row 5, Column 8
0%
Row 5, Column 9
1
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10
Humanity
What ignites your Humanity?
100%
90%
75%
65%
50%
40%
35%
25%
15%
0%
Compassion
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
Row 0, Column 7
Row 0, Column 8
Row 0, Column 9
Empathy
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Row 1, Column 7
Row 1, Column 8
Row 1, Column 9
Generosity
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
Row 2, Column 7
Row 2, Column 8
Row 2, Column 9
Kindness
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
Row 3, Column 7
Row 3, Column 8
Row 3, Column 9
Love
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Row 4, Column 6
Row 4, Column 7
Row 4, Column 8
Row 4, Column 9
Social Intelligence
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Row 5, Column 6
Row 5, Column 7
Row 5, Column 8
Row 5, Column 9
Compassion
Empathy
Generosity
Kindness
Love
Social Intelligence
100%
Row 0, Column 0
90%
Row 0, Column 1
75%
Row 0, Column 2
65%
Row 0, Column 3
50%
Row 0, Column 4
40%
Row 0, Column 5
35%
Row 0, Column 6
25%
Row 0, Column 7
15%
Row 0, Column 8
0%
Row 0, Column 9
100%
Row 1, Column 0
90%
Row 1, Column 1
75%
Row 1, Column 2
65%
Row 1, Column 3
50%
Row 1, Column 4
40%
Row 1, Column 5
35%
Row 1, Column 6
25%
Row 1, Column 7
15%
Row 1, Column 8
0%
Row 1, Column 9
100%
Row 2, Column 0
90%
Row 2, Column 1
75%
Row 2, Column 2
65%
Row 2, Column 3
50%
Row 2, Column 4
40%
Row 2, Column 5
35%
Row 2, Column 6
25%
Row 2, Column 7
15%
Row 2, Column 8
0%
Row 2, Column 9
100%
Row 3, Column 0
90%
Row 3, Column 1
75%
Row 3, Column 2
65%
Row 3, Column 3
50%
Row 3, Column 4
40%
Row 3, Column 5
35%
Row 3, Column 6
25%
Row 3, Column 7
15%
Row 3, Column 8
0%
Row 3, Column 9
100%
Row 4, Column 0
90%
Row 4, Column 1
75%
Row 4, Column 2
65%
Row 4, Column 3
50%
Row 4, Column 4
40%
Row 4, Column 5
35%
Row 4, Column 6
25%
Row 4, Column 7
15%
Row 4, Column 8
0%
Row 4, Column 9
100%
Row 5, Column 0
90%
Row 5, Column 1
75%
Row 5, Column 2
65%
Row 5, Column 3
50%
Row 5, Column 4
40%
Row 5, Column 5
35%
Row 5, Column 6
25%
Row 5, Column 7
15%
Row 5, Column 8
0%
Row 5, Column 9
1
of 6
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11
Patience
Do you have the Patience to pursue your Passions?
100%
90%
75%
65%
50%
40%
35%
25%
15%
0%
Empathy
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
Row 0, Column 7
Row 0, Column 8
Row 0, Column 9
Hope
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Row 1, Column 7
Row 1, Column 8
Row 1, Column 9
Open Minded
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
Row 2, Column 7
Row 2, Column 8
Row 2, Column 9
Perspective
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
Row 3, Column 7
Row 3, Column 8
Row 3, Column 9
Empathy
Hope
Open Minded
Perspective
100%
Row 0, Column 0
90%
Row 0, Column 1
75%
Row 0, Column 2
65%
Row 0, Column 3
50%
Row 0, Column 4
40%
Row 0, Column 5
35%
Row 0, Column 6
25%
Row 0, Column 7
15%
Row 0, Column 8
0%
Row 0, Column 9
100%
Row 1, Column 0
90%
Row 1, Column 1
75%
Row 1, Column 2
65%
Row 1, Column 3
50%
Row 1, Column 4
40%
Row 1, Column 5
35%
Row 1, Column 6
25%
Row 1, Column 7
15%
Row 1, Column 8
0%
Row 1, Column 9
100%
Row 2, Column 0
90%
Row 2, Column 1
75%
Row 2, Column 2
65%
Row 2, Column 3
50%
Row 2, Column 4
40%
Row 2, Column 5
35%
Row 2, Column 6
25%
Row 2, Column 7
15%
Row 2, Column 8
0%
Row 2, Column 9
100%
Row 3, Column 0
90%
Row 3, Column 1
75%
Row 3, Column 2
65%
Row 3, Column 3
50%
Row 3, Column 4
40%
Row 3, Column 5
35%
Row 3, Column 6
25%
Row 3, Column 7
15%
Row 3, Column 8
0%
Row 3, Column 9
1
of 4
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12
Honor
Will you pursue your Passions with Honor?
100%
90%
75%
65%
50%
40%
35%
25%
15%
0%
Honesty
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
Row 0, Column 7
Row 0, Column 8
Row 0, Column 9
Integrity
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Row 1, Column 7
Row 1, Column 8
Row 1, Column 9
Trustworthiness
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
Row 2, Column 7
Row 2, Column 8
Row 2, Column 9
Honesty
Integrity
Trustworthiness
100%
Row 0, Column 0
90%
Row 0, Column 1
75%
Row 0, Column 2
65%
Row 0, Column 3
50%
Row 0, Column 4
40%
Row 0, Column 5
35%
Row 0, Column 6
25%
Row 0, Column 7
15%
Row 0, Column 8
0%
Row 0, Column 9
100%
Row 1, Column 0
90%
Row 1, Column 1
75%
Row 1, Column 2
65%
Row 1, Column 3
50%
Row 1, Column 4
40%
Row 1, Column 5
35%
Row 1, Column 6
25%
Row 1, Column 7
15%
Row 1, Column 8
0%
Row 1, Column 9
100%
Row 2, Column 0
90%
Row 2, Column 1
75%
Row 2, Column 2
65%
Row 2, Column 3
50%
Row 2, Column 4
40%
Row 2, Column 5
35%
Row 2, Column 6
25%
Row 2, Column 7
15%
Row 2, Column 8
0%
Row 2, Column 9
1
of 3
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13
Knowledge
How do you apply your Knowledge to pursue & achieve your Passions?
100%
90%
75%
65%
50%
40%
35%
25%
15%
0%
Love of learning
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
Row 0, Column 7
Row 0, Column 8
Row 0, Column 9
Innovative
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Row 1, Column 7
Row 1, Column 8
Row 1, Column 9
Judgment
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
Row 2, Column 7
Row 2, Column 8
Row 2, Column 9
Confidence
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
Row 3, Column 7
Row 3, Column 8
Row 3, Column 9
Love of learning
Innovative
Judgment
Confidence
100%
Row 0, Column 0
90%
Row 0, Column 1
75%
Row 0, Column 2
65%
Row 0, Column 3
50%
Row 0, Column 4
40%
Row 0, Column 5
35%
Row 0, Column 6
25%
Row 0, Column 7
15%
Row 0, Column 8
0%
Row 0, Column 9
100%
Row 1, Column 0
90%
Row 1, Column 1
75%
Row 1, Column 2
65%
Row 1, Column 3
50%
Row 1, Column 4
40%
Row 1, Column 5
35%
Row 1, Column 6
25%
Row 1, Column 7
15%
Row 1, Column 8
0%
Row 1, Column 9
100%
Row 2, Column 0
90%
Row 2, Column 1
75%
Row 2, Column 2
65%
Row 2, Column 3
50%
Row 2, Column 4
40%
Row 2, Column 5
35%
Row 2, Column 6
25%
Row 2, Column 7
15%
Row 2, Column 8
0%
Row 2, Column 9
100%
Row 3, Column 0
90%
Row 3, Column 1
75%
Row 3, Column 2
65%
Row 3, Column 3
50%
Row 3, Column 4
40%
Row 3, Column 5
35%
Row 3, Column 6
25%
Row 3, Column 7
15%
Row 3, Column 8
0%
Row 3, Column 9
1
of 4
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14
Wisdom
How do you utilize your Wisdom to enhance your superpowers?
100%
90%
75%
65%
50%
40%
35%
25%
15%
0%
Creativity
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
Row 0, Column 7
Row 0, Column 8
Row 0, Column 9
Curiosity
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Row 1, Column 7
Row 1, Column 8
Row 1, Column 9
Perspective
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
Row 2, Column 7
Row 2, Column 8
Row 2, Column 9
Spirituality
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
Row 3, Column 7
Row 3, Column 8
Row 3, Column 9
Creativity
Curiosity
Perspective
Spirituality
100%
Row 0, Column 0
90%
Row 0, Column 1
75%
Row 0, Column 2
65%
Row 0, Column 3
50%
Row 0, Column 4
40%
Row 0, Column 5
35%
Row 0, Column 6
25%
Row 0, Column 7
15%
Row 0, Column 8
0%
Row 0, Column 9
100%
Row 1, Column 0
90%
Row 1, Column 1
75%
Row 1, Column 2
65%
Row 1, Column 3
50%
Row 1, Column 4
40%
Row 1, Column 5
35%
Row 1, Column 6
25%
Row 1, Column 7
15%
Row 1, Column 8
0%
Row 1, Column 9
100%
Row 2, Column 0
90%
Row 2, Column 1
75%
Row 2, Column 2
65%
Row 2, Column 3
50%
Row 2, Column 4
40%
Row 2, Column 5
35%
Row 2, Column 6
25%
Row 2, Column 7
15%
Row 2, Column 8
0%
Row 2, Column 9
100%
Row 3, Column 0
90%
Row 3, Column 1
75%
Row 3, Column 2
65%
Row 3, Column 3
50%
Row 3, Column 4
40%
Row 3, Column 5
35%
Row 3, Column 6
25%
Row 3, Column 7
15%
Row 3, Column 8
0%
Row 3, Column 9
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15
Transcendence
Are you ready to take the leap of Transcendence to fulfill your full potential?
100%
90%
75%
65%
50%
40%
35%
25%
15%
0%
Altruism
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
Row 0, Column 5
Row 0, Column 6
Row 0, Column 7
Row 0, Column 8
Row 0, Column 9
Appreciation of beauty
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
Row 1, Column 5
Row 1, Column 6
Row 1, Column 7
Row 1, Column 8
Row 1, Column 9
Gratitude
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
Row 2, Column 5
Row 2, Column 6
Row 2, Column 7
Row 2, Column 8
Row 2, Column 9
Hope
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 3, Column 5
Row 3, Column 6
Row 3, Column 7
Row 3, Column 8
Row 3, Column 9
Humor
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Row 4, Column 5
Row 4, Column 6
Row 4, Column 7
Row 4, Column 8
Row 4, Column 9
Love
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
Row 5, Column 5
Row 5, Column 6
Row 5, Column 7
Row 5, Column 8
Row 5, Column 9
Altruism
Appreciation of beauty
Gratitude
Hope
Humor
Love
100%
Row 0, Column 0
90%
Row 0, Column 1
75%
Row 0, Column 2
65%
Row 0, Column 3
50%
Row 0, Column 4
40%
Row 0, Column 5
35%
Row 0, Column 6
25%
Row 0, Column 7
15%
Row 0, Column 8
0%
Row 0, Column 9
100%
Row 1, Column 0
90%
Row 1, Column 1
75%
Row 1, Column 2
65%
Row 1, Column 3
50%
Row 1, Column 4
40%
Row 1, Column 5
35%
Row 1, Column 6
25%
Row 1, Column 7
15%
Row 1, Column 8
0%
Row 1, Column 9
100%
Row 2, Column 0
90%
Row 2, Column 1
75%
Row 2, Column 2
65%
Row 2, Column 3
50%
Row 2, Column 4
40%
Row 2, Column 5
35%
Row 2, Column 6
25%
Row 2, Column 7
15%
Row 2, Column 8
0%
Row 2, Column 9
100%
Row 3, Column 0
90%
Row 3, Column 1
75%
Row 3, Column 2
65%
Row 3, Column 3
50%
Row 3, Column 4
40%
Row 3, Column 5
35%
Row 3, Column 6
25%
Row 3, Column 7
15%
Row 3, Column 8
0%
Row 3, Column 9
100%
Row 4, Column 0
90%
Row 4, Column 1
75%
Row 4, Column 2
65%
Row 4, Column 3
50%
Row 4, Column 4
40%
Row 4, Column 5
35%
Row 4, Column 6
25%
Row 4, Column 7
15%
Row 4, Column 8
0%
Row 4, Column 9
100%
Row 5, Column 0
90%
Row 5, Column 1
75%
Row 5, Column 2
65%
Row 5, Column 3
50%
Row 5, Column 4
40%
Row 5, Column 5
35%
Row 5, Column 6
25%
Row 5, Column 7
15%
Row 5, Column 8
0%
Row 5, Column 9
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16
What sectors do you identify as most important for a thriving community?
Education and Apprenticeship
Art and Music
Churches and Local Non-profits
News and Media
Private Business Sector
Workforce and Labor Unions
Public Service Sector - Local Government
Medical Health/Wellness and Fitness
Science and Technology
Family and Friends
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17
How is your time being spent?
Please provide a brief estimate of how much time you dedicate each week to the following activities.
Days
Hours
Minutes
Work
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Hobbies
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
R & R
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Exercise
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Social
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Family
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Education
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Meditation
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Other
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Work
Hobbies
R & R
Exercise
Social
Family
Education
Meditation
Other
Days
Row 0, Column 0
Hours
Row 0, Column 1
Minutes
Row 0, Column 2
Days
Row 1, Column 0
Hours
Row 1, Column 1
Minutes
Row 1, Column 2
Days
Row 2, Column 0
Hours
Row 2, Column 1
Minutes
Row 2, Column 2
Days
Row 3, Column 0
Hours
Row 3, Column 1
Minutes
Row 3, Column 2
Days
Row 4, Column 0
Hours
Row 4, Column 1
Minutes
Row 4, Column 2
Days
Row 5, Column 0
Hours
Row 5, Column 1
Minutes
Row 5, Column 2
Days
Row 6, Column 0
Hours
Row 6, Column 1
Minutes
Row 6, Column 2
Days
Row 7, Column 0
Hours
Row 7, Column 1
Minutes
Row 7, Column 2
Days
Row 8, Column 0
Hours
Row 8, Column 1
Minutes
Row 8, Column 2
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18
Appointment/ Consultation
Redeem your free tea sample from Herbalicious Bliss. Let's connect! We want to learn more about your passions and how we can support your vision moving forward.
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19
Phone Number
Please enter a valid phone number.
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20
What is the best way to connect?
Please let us know the best way to connect with you.
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