Midlife Glow Up Survey
Unlock your best self with our S.H.I.N.E framework questionare. Answer these quick questions to assess where you are on your MIDLIFE glow-up journey and get personalized tips to level up your self-care, habits, interests, networks and experiences.
Name
First Name
Last Name
Email
example@example.com
SELF-CARE & WELL-BEING
1.1 How often do you prioritize self care?
Daily
A few times a week
Occasionally
Rarely
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1.2 What’s your biggest self- care challenge?
Lack of time
Guilt for focusing on myself
Not sure what works for me
Inconsistency
Other
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1.3 How would you rate your current confidence level? ( 1 = not confident, 5 = thriving)
1
2
3
4
5
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1.4 Do you have a morning or evening routine that supports your well-being?
Yes, both
Just a morning routine
Just an evening routine
No,but I’d love to start one
No, and I’m not sure where to begin
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HABITS & LIFESTYLE
2.1 Which area of your life do you most want to improve? (Choose up to 2)
Fitness & movement
Nutrition & mindful clarity
Mindset & mental clarity
Sleep & relaxation
Beauty & skincare
Productivity & time management
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2.2. What’s your biggest struggle with staying consistent?
Lack of motivation
No clear plan
Too many distractions
Not seeing results fast enough
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2.3 If you could change ONE daily habit to boost your glow-up, what would that be?
Drink more water
Get better sleep
Move my body daily
Practice gratitude & self love
Stick to a skincare routine
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INTERESTS & HOBBIES
3..1 What brings you joy and makes your feel alive? (Check all that applies)
Creative activities (art,music,writing)
Fitness & movement (yoga,dancing, running)
Learning new skills (courses, books, podcast)
Socializing & making connections
Traveling & new experiences
Other
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3.2 how often do you make time for these activities?
Regularly
Sometimes
Rarely
Never
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NETWORK & SOCIAL LIFE
4.1 How supported do you feel by your social circle?
Very supported
Somewhat supported
Neutral
Not very supported
I feel isolated
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4.2 Do you have a mentor, coach, or support system that helps you grow?
Yes, it’s been life changing
Yes, but I don’t use it enough
No, but I’d love that
No, I don’t think I need one
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4.3 Would you benefit from a community of like-minded women on the same glow up journey?
Absolutely! I’d love that
Maybe, if its the right fit
Not sure
No, I prefer doing it solo.
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EXPERIENCES & NEXT STEPS
5.1 How open are you to trying new experiences for self growth?
Always looking for new things to try
Open, but I need a little push
Cautious, but curious
I like to stick with what I know
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5.2 Are you ready to commit to a FREE 21-Day Glow Up Challenge using my S.H.I.N.E framework to elevate into your best self?
Yes! Im ready to glow up
Maybe, I need more details
Not sure, but I’m curious
No, not right now
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5.3 Would you like a special offer on THE MIDLIFE GLOW UP Guide to kickstart your journey?
Yes, send it my way
Maybe, tell me more
No. I’ll think about it
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