Discovery Prep Questionnaire

Thank you for your interest in exploring the possibility of our supporting your journey to greater vibrance and health. This questionnaire is intended to help us understand your current perspectives on important life aspects. We strive to understand your whole view of the world around you and how it relates to your personal health and well-being.

 

Holistic Health Status Questionnaire

Using the “scale from 10 to 1” where do you stand at the moment?

“10” = “I completely agree with this statement, right now.”
“5”   = “I somewhat agree with this statement, right now.”
“1”   = “I completely disagree with this statement, right now.”

Please review and rate the following to indicate the intensity of your current perspective.

 

A. I want to inspire the people I serve and work with, by practicing good health habits and truly seeing my self-worth.

 

B. I regularly communicate with a strong support network that helps me stay “on track” with my personal goals and visions.

 

C. I make commitments and keep them.

 

D. Honesty and integrity are high on my priority list in everything I say and do.

 

E. I let go of thoughts, things, and people that hold me back from expressing myself and exploring my talents.

 

F. I appreciate the connection between the water I drink, the health of my body, and my relationship with all forms of life on Earth.

 

G. My internal organs are just as important as my outsides–skin, hair, eyes, teeth, and more.

 

H. My source, the Universe, God, or Higher Power offers me wisdom, strength, and energy to overcome any of my challenges, like with health, money, and relationships.

 

I. What I resist persists, and I am ready to view and do things differently.

 

J. I see both the blessings and drawbacks of my old patterns and compulsive tendencies.

 

K. Time is my servant, and I trust my ability to invest time in myself.

 

L. Teamwork inspires and motivates me more than working alone.

 

M. I have noticed that the foods I eat affect my mood, mental clarity, and overall health.

 

N. I welcome change, so that I can produce new results, whether or not I understand everything.

 

 

Copyright 2014 Ilana Kristeva