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Choose Your Life
Please take the time to fill in your details and answer the questions below to raise your awareness in these important area - have fun and feel free to email us with any insights or questions!
*Full Name:
Company:
*Email:
*State:
*Phone:
*Country:
In general, how satisfied are you with your life right now?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Are you living the life that you would ideally choose?
Yes
No
How often do you stop and consider making changes to your life?
Consistently
Regularly
Occasionally
Rarely
How successful are you at making any life changes that you identify?
Very
Moderately
Occasionally
Rarely
Never
How often do you set life goals?
Often
Sometimes
Never
Would you like to have more opportunity to reflect on your life, set new goals and explore new ideas?
Yes
No
How balanced does your life feel right now?
Exactly as I want to be
Just about right
A bit out of balance
Out of control
Where/ to whom are you most likely to look for support when facing a problem?
Spouse / Partner
Work Colleagues
Friends
Coach / Mentor
Other Family
Someone else
Typically, how much stress is in your life?
Just enough
More than I would like
Far too much
Would you like to improve or make changes to your life?
Yes
No
What areas of your life would you like to improve or make changes to?
Health
Finances
Personal Growth
Goal setting / Reflection
Work / Career
Family
Relationships
Feelings
Society I live in
Time for me
Overall, how happy are you with your life?
Very
Moderately
Would like to be happier
Generally unhappy
Not at all
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