The purpose of this brief Questionnaire is to establish how you feel about yourself and your world ~ and to identify specific issues you may like to examine.

If you do not wish to answer a particular question, just leave a blank. Along with all that we do here, your answers will remain entirely confidential.

My Name:

My E-mail Address:

Please rate 0-10
with 10 being perfect

COMMENT

Relationship with partner

Relationships with family

Relationships at work

Other work-related issues

My physical health/energy

My sense of self worth

My experience of abundance

My feeling of spirituality

My state of happiness

My sense of belonging

My particular likes

Particular dislikes

(Please identify your beliefs)

My approach to life significantly affects it

Yes   Not Sure    No

An open mind is a weak mind

Yes   Not Sure    No

No-one can help me if I don't want them to

Yes   Not Sure    No

Many of my problems are attributable to others

Yes   Not Sure    No

Others will change as I do

Yes   Not Sure    No

Life is hard

Yes   Not Sure    No

I deserve everything that is good

Yes   Not Sure    No

I am loved

Yes   Not Sure    No

I am powerless to change my life

Yes   Not Sure    No

(Please select all that apply)

Angry

Sad

Guilty

Tired

Stuck

Happy

Contented

Confused

Betrayed

Silly

Numb

Fearful

Lonely

Apprehensive

Put-upon

Unloved

In participating in an event with Vision unlimited, I would really like to...

 

Please use this space to tell us anything else about yourself that you
consider relevant ~ and to ask any questions you may have about
what we do and how we do it...

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