I Before We - Pre-Program Survey

I Before We - Pre-Program Survey

Answer the 5 statements below and complete two short reflections about where you’re starting and what you’re feeling as we begin.
I understand the patterns that show up in how I relate to others.

1

2

3

4

5

1 is 1 (Strongly Disagree), 5 is 5 (Strongly Agree)
I can recognize when an old wound—not the present moment—is driving my reaction.

1

2

3

4

5

1 is 1 (Strongly Disagree), 5 is 5 (Strongly Agree)
I feel worthy of love and care, independent of what I do for someone else.

1

2

3

4

5

1 is 1 (Strongly Disagree), 5 is 5 (Strongly Agree)
I can set a boundary without over-explaining or apologizing for it.

1

2

3

4

5

1 is 1 (Strongly Disagree), 5 is 5 (Strongly Agree)
I know what I need in a relationship, and I'm able to say it out loud.

1

2

3

4

5

1 is 1 (Strongly Disagree), 5 is 5 (Strongly Agree)
Describe where you're starting from today, and where you hope to be by the end of these six weeks.
Is there anything that you are anxious about as we begin this work together? If yes, please share what you are feeling anxious about.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How would you like to be invoiced?

Other
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