You can always press Enter⏎ to continue
Welcome
Hi there, please fill out and submit this form.
24
Questions
START
1
Image Field
Previous
Next
Submit
Press
Enter
2
Name
First Name
Last Name
Previous
Next
Submit
Press
Enter
3
Email
example@example.com
Previous
Next
Submit
Press
Enter
4
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Previous
Next
Submit
Press
Enter
5
Phone Number
Please enter a valid phone number.
Previous
Next
Submit
Press
Enter
6
What is your biggest goal right now?
Build better daily habits 🛁
Be more productive and organized 🧠
Improve my emotional awareness 🥰
Practice mindfulness and gratitude 🧘🏼♀️
Previous
Next
Submit
Press
Enter
7
How do you like to structure your day?
I prefer simple check-ins ✔️
I love detailed planning 📋
I focus on understanding my own feelings and how to improve my relationships 🫶🏼
I reflect when I have time 🕯️
Previous
Next
Submit
Press
Enter
8
Your biggest challenge with self-improvement?
Staying organized and starting self-care 👟
Staying organized and motivated 🙈
Managing my stress, relationships and communication 💬
Not knowing where to start or feeling stuck 🤷🏽♀️
Previous
Next
Submit
Press
Enter
9
How do you approach goal setting?
I need to structure my day with healthy habits & self-care first 💅🏿
I need daily to do-lists and tasks to check off first ☑️
I focus on understanding my emotions and relationships first 👩❤️👨
I need to reflect on each day and how to improve for the next day 🔨
Previous
Next
Submit
Press
Enter
10
How do you normally structure your day?
Around my self-care and wellness activities 🚿
I have a detailed schedule and have little time to journal or reflect 🗂️
I try to address challenges as they arise 🧎🏼♀️
I like to wake up and set intention and reflect before bed ☕️
Previous
Next
Submit
Press
Enter
11
What is your biggest time management struggle?
Staying consistent with healthy routines 🥕
Prioritizing tasks and not multitasking 🎧
Letting my emotions cloud my judgment where it affects my goals and relationships 🥅
Setting intentions and sticking to them and reflecting 🎀
Previous
Next
Submit
Press
Enter
12
How do you handle stress?
Using a self-care ritual 🧖🏻♀️
Staying productive 🧳
By trying to understand the root cause 🔎
Journaling and reflecting 📓
Previous
Next
Submit
Press
Enter
13
What is your biggest challenge when it comes to emotions?
Managing my stress in a healthy way 🤸🏾
Staying focused despite distractions 🪩
Knowing what my emotions are telling me and how to navigate them 🖤
Making time to reflect and process them 🤔
Previous
Next
Submit
Press
Enter
14
How often do you reflect on your emotions?
Rarely - I focus on my self-care routine 💆🏽♀️
Only when I feel overwhelmed 🤯
Daily - it helps me stay grounded 😊
I like to reflect overall at night 🌙
Previous
Next
Submit
Press
Enter
15
What is one habit you wish you could stick to?
Drinking more water 💧
Organizing my time ⏰
Managing my emotions effectively 🤬
Reflecting 🙏🏻
Previous
Next
Submit
Press
Enter
16
What is your biggest self-care challenge?
I focus on others and not myself 🤰🏼
Building it into my busy day 👩🏾🏫
I have too much baggage and my relationships drain me 🥶
Waking up in a bad mood that paves the way for a bad day 🥵
Previous
Next
Submit
Press
Enter
17
What is the most important feature in a mindfulness tool for you?
Habit tracking and self-care focus ✍🏼
Structure and organization to my day ⚖️
Guidance for emotional challenges 🪫
Space to reflect and express gratitude ☺️
Previous
Next
Submit
Press
Enter
18
How often do you journal or write down your thoughts?
I mostly track habits, not thoughts 📊
Rarely, I don’t have time 📑
Occasionally, when something or someone is bothering me ❤️🩹
Daily, I love reflecting ☀️
Previous
Next
Submit
Press
Enter
19
How do you stay present during the day?
Engaging in self-care activities ♻️
By staying on tract with my organization and productivity ‼️
Practicing emotional awareness 👁️
By pausing and reflecting in the morning and at night ⏸️
Previous
Next
Submit
Press
Enter
20
What motivates you to be productive?
Seeing progress in my habits 📈
Goal-setting and checklists 🏁
Resolving emotional stressors 😖
Knowing I’m growing as a person 😇
Previous
Next
Submit
Press
Enter
21
What’s your biggest productivity struggle?
Balancing work, life and self-care 🛟
Staying focused, achieving goals, and completing tasks 💪🏻
Feeling overwhelmed by my emotions 🥺
Finding time and learning to reflect 🫥
Previous
Next
Submit
Press
Enter
22
How do you celebrate your accomplishments?
By rewarding myself with rest after seeing my self-care progress 😌
By checking off tasks ✅
By recognizing how far I’ve come emotionally 👩🏾🤝👨🏻
By writing down what I’m grateful for 🏡
Previous
Next
Submit
Press
Enter
23
How much time do you have or want to spend with your mindfulness product per day?
5 - 10 minutes (here and there throughout the day to track my progress)
20 + minutes (I need structure and guidance)
5 - 10 minutes (when I feel emotionally overwhelmed and need a roadmap)
10-15 minutes (between my morning and night journal routines)
Previous
Next
Submit
Press
Enter
24
What’s one area of your life that needs the most attention right now?
Self-care and healthy habits 🥬
Productivity and time management ⌚️
Emotional resilience and awareness 🪷
Gratitude, reflection and mindfulness 🌷
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
24
See All
Go Back
Submit