Name Email Step 1 of 2 1. Your Name Your Name Your Email 3. Choose the TWO states you want more of in your life right now. Successful Loved Enough Safe Confident Peaceful You may select a maximum of 2 options. 4. I feel truly SUCCESSFUL when… (Check all that apply) …I hit my goals …I'm making more money than last year …people see my results …I'm ahead, not behind …I'm productive all day …I'm not failing at anything …I'm respected for what I do …I feel in control of my schedule …I'm not overwhelmed by responsibilities …I'm providing for others …I'm disciplined with my habits …I'm not disappointing anyone …I'm doing something meaningful …I'm winning in more than one area of life You may select a maximum of 1 options. 5. How many of the above rules on SUCCESS must be true at the same time for you to feel successful? 1 2 3 4 5 You may select a maximum of 1 options. 6. If one SUCCESSFUL rule is missing, do you lose the feeling of being successful? 1 = Almost never | 2 = Rarely | 3 = Sometimes | 4 = Often | 5 = Almost always 1 2 3 4 5 7. I feel truly LOVED when… (Check all that apply) …someone chooses me …I feel appreciated …I'm wanted, not just needed …I'm understood …I'm not being criticized …I'm not "too much" …I'm not rejected …I'm not alone …I feel safe to be myself …I'm being touched, hugged, or held …I'm listened to …we have time together …I'm forgiven for my mistakes …I'm accepted even when I'm struggling You may select a maximum of 1 options. 8. How many of the above rules on BEING LOVED must be true at the same time for you to feel loved? 1 2 3 4 5 You may select a maximum of 1 options. 9. If one LOVED rule is missing, do you lose the feeling of being loved? 1 = Almost never | 2 = Rarely | 3 = Sometimes | 4 = Often | 5 = Almost always 1 2 3 4 5 10. I feel truly ENOUGH when… (Check all that apply) …I did what I said I'd do …I didn't let anyone down …I'm not behind …I'm not making mistakes …I'm doing my best …I'm improving …I'm not judged …I'm not compared to others …I'm not lazy …I'm strong and capable …I'm contributing …I'm needed …I'm valuable …I'm handling my responsibilities You may select a maximum of 1 options. 11. How many of the above rules on BEING ENOUGH must be true at the same time for you to feel enough? 1 2 3 4 5 You may select a maximum of 1 options. 12. If one ENOUGH rule is missing, do you lose the feeling of being enough? 1 = Almost never | 2 = Rarely | 3 = Sometimes | 4 = Often | 5 = Almost always 1 2 3 4 5 13. I feel truly SAFE when… (Check all that apply) …nothing unexpected happens …I'm not at risk financially …I'm not being attacked or judged …I'm not in conflict …I have a plan …I know what's coming next …I'm in control …my body feels calm …I'm not exposed or vulnerable …I'm not alone in it …I trust the people around me …I have enough resources …I'm not making the wrong decision …I'm prepared You may select a maximum of 1 options. 14. How many of the above rules on SAFETY must be true at the same time for you to feel safe? 1 2 3 4 5 You may select a maximum of 1 options. 15. If one SAFE rule is missing, do you lose the feeling of being safe? 1 = Almost never | 2 = Rarely | 3 = Sometimes | 4 = Often | 5 = Almost always 1 2 3 4 5 16. I feel truly CONFIDENT when… (Check all that apply) …I know what I'm doing …I have proof I can do it …I look competent …I'm respected …I'm not questioned …I'm not making mistakes …I'm prepared …I feel strong in my body …I'm clear on what to say …I'm getting results …I'm not being judged …I'm in my lane …I'm leading …I trust myself You may select a maximum of 1 options. 17. How many of the above rules on CONFIDENCE must be true at the same time for you to feel confident? 1 2 3 4 5 You may select a maximum of 1 options. 18. If one CONFIDENT rule is missing, do you lose the feeling of being confident? 1 = Almost never | 2 = Rarely | 3 = Sometimes | 4 = Often | 5 = Almost always 1 2 3 4 5 19. I feel truly PEACEFUL when… (Check all that apply) …everything is handled …my to-do list is under control …there's no conflict …I'm not rushed …I'm not overwhelmed …I have quiet and space …I'm in nature …I've done enough for the day …I'm not worrying about money …I'm not carrying other people's emotions …my body feels relaxed …I'm not being pulled in ten directions …I feel close to God …I feel grateful You may select a maximum of 1 options. Next Step 2 of 2 20. How many of the above rules on PEACE must be true at the same time for you to feel peaceful? 1 2 3 4 5 You may select a maximum of 1 options. 21. If one PEACEFUL rule is missing, do you lose the feeling of being peaceful? 1 = Almost never | 2 = Rarely | 3 = Sometimes | 4 = Often | 5 = Almost always 1 2 3 4 5 Previous Submit
