First Name *

Last Name

Phone

Email *

Q1. When something unexpected or stressful happens, how do you typically respond? *

I react instantly and often regret it.

I realize I’m reacting… but only after I blow up or shut down.

I can catch myself sometimes and redirect.

I pause, breathe, and choose my response.

I stay centered—"stress" doesn’t pull me off my path.

Q2. How aware are you of your thoughts throughout the day? *

I don’t notice them—they run the show.

I notice them occasionally but they still control my mood.

I’m becoming aware and can redirect them sometimes.

I’m conscious of my thoughts most of the day.

I observe thoughts without attaching to them.

Q3. What best describes your emotional state on an average day? *

Overwhelmed or chaotic.

I am noticing that I am often reactive/triggered.

Generally aware, but inconsistent

Grounded and intentional.

Peaceful, powerful, and steady.

Q4. How do you handle conflict or confrontation? *

I avoid it or react defensively.

I try to hold it together but often get triggered.

I can stay neutral sometimes but not always.

I communicate clearly and stay in control of myself.

I lead the conversation with clarity and calm regardless of the situation.

Q5. Which best describes your internal dialogue? *

Chaotic. Negative. Constantly beating myself up.

A mix of negativity and occasional insight.

Becoming more encouraging as I catch patterns.

Supportive, grounded, intentional.

Empowering, clear, and rooted in truth.

Q6. How intentional are your daily choices and actions? *

I operate on autopilot.

I try to be intentional but often fall back into old habits.

I’m building routines but still inconsistent.

I follow through on most intentions.

I live with deep clarity, alignment, and discipline.

Q7. How much do other people’s opinions affect you? *

A lot—I replay conversations and question myself.

They still influence me more than I like.

I’m learning to detach from them.

I’m mostly unaffected—my opinion of myself matters most.

I am completely rooted in my identity—outside opinions don’t shake me.

Q8. When you make a mistake, what’s your response? *

I beat myself up or spiral downward.

I dwell on it but eventually move on.

I’m working on viewing mistakes as feedback.

I evaluate, adjust, and keep going.

I welcome mistakes as data for mastery.

Q9. How consistent is your personal growth work? *

I don’t do personal growth—I’m just surviving.

I start and stop constantly.

I’m trying to build habits and be more intentional

I stay consistent most of the time.

Growth is my identity—it’s non-negotiable.

Q10. How would someone close to you describe your presence and energy? *

Reactive, overwhelmed, or unpredictable.

Trying but still triggered often.

Calmer than before but still working on it.

Grounded, steady, and clear.

Powerful, centered, and almost impossible to shake.

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