Blissipline Plan
1-on-1 with SoulMystic
Discovery & Fit Questionnaire
Fill this out to apply for a customized Blissipline plan and 1-on-1 time with SoulMystic. Your answers help us personalize your plan around your goals, lifestyle, and current season of life. If chosen, you’ll be shown next steps (and we may follow up with a few clarifying questions).
Section 1: Contact + Basics
First things first. Tell me some of your demographic background and how you'd like me to refer to you!
Preferred Name
*
First Name
Last Name
Legal Name (if different from above)
First Name
Last Name
Pronouns
Please list all pronouns you identify with - feel free to leave blank if you prefer to only be referred to by name!
E-mail
*
example@example.com
Phone Number
-
Area Code
Phone Number
How May I Reach You At This Number?
Please Select
Call
Text
Call & Text
E-mail Only Please
Time Zone
Please Select
Eastern
Central
Mountain
Pacific
Alaska/Hawaii
UK/Europe
Other
For scheduling our calls.
Date of Birth
-
Month
-
Day
Year
Date
Cultural Considerations (anything that feels important for me to know about who you are, the sociocultural locations you inhabit, and what may be helpful for me to make your Blissipline plan as supportive as possible)
Consider areas such as: Race/Ethnicity, Gender Identity, Sexual Orientation, Disability or Chronic Illness, etc.
How Did You Discover My Services?
Please Select
Instagram
YouTube
Facebook
TikTok
Website/Google
Friend/Word of Mouth
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Section 2: What You Want (Goals + Outcome)
What are you hoping Blissipline helps you create in your life right now?
Choose your top 1–3 focus areas
Consistency / discipline
Anxiety / overthinking
Confidence / self-worth
Energy / motivation
Spiritual connection / mindfulness
Creativity / expression
Health habits / body care
Relationships / communication
Purpose / direction
Money mindset / Abundance
Other
If we fast-forward 30 days, what would make you say ‘this worked’?
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Section 3: Your Current Reality (So the plan is realistic)
What’s your biggest challenge right now?
I feel disconnected spiritually
I start strong then fall off
TypeI feel overwhelmed / scattered
I don’t know what to prioritize
I’m burned out
I’m inconsistent with sleep / routines
I’m hard on myself / perfectionist
Other
What have you already tried? What helped (even a little)?
How much time can you realistically commit per day?
Please Select
5 minutes
10 minutes
15 minutes
20 minutes
30 minutes
45+ minutes
Preferred style of plan
Simple + minimal (small daily actions
Balanced (a few daily actions + weekly deeper work)
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Section 4: Blissipline Fit
On a scale of 1–10, how ready are you to commit to a plan for the next 30 days?
1
2
3
4
5
6
7
8
9
10
Not Ready
Let's go!
1 is Not Ready, 10 is Let's go!
What usually knocks you off track?
Time / schedule
Stress / emotions
Low energy
Social media / distractions
Lack of clarity
Lack of support
Self-doubt
Other
What kind of support helps you most?
Clear structure + steps
Encouragement / mindset support
Accountability / check-ins
Spiritual framing / meaning
Practical tools + templates
Gentle flexibility (not rigid)
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Section 5: The 1-on-1 With SoulMystic (Expectations)
What would you most want to use your 1-on-1 time for?
Clarify my goals + direction
Identify my biggest blockers
Create a daily routine that fits my life
Mindset + spiritual alignment
Accountability + next steps
Any topics you do NOT want to discuss? (optional)
Anything SoulMystic should know to support you well?
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Section 6: Payment / Investment
If accepted, are you ready to invest in a paid customized plan + 1-on-1 time?
Yes
I have questions first
Not right now
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Section 7: Agreement
"I understand this is a personalized plan based on the information I provide.I understand results depend on my participation and follow-through.I agree to be contacted by email/text about next steps."
Agreement
I agree
Signature
Final question: Why NOW?
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Whew! You Did It!!!
Thank you — your Blissipline intake is received. Next step: keep an eye on your email for confirmation + details. If we need any clarifying info, we’ll reach out.
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Submit!
Submit!
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