Name
*
First Name
Last Name
Select any areas in your life you get a lot of joy from right now or feel strong in
*
Relationship to motion, exercise, physical strength
Sense of mental + emotional flexibility or spaciousness
"Work-life balance"
Sense of harmony with eating practices
Relationship with time (navigating deadlines, sense of ease, etc.)
Romance
Friendships + social time
Housekeeping/homemaking
Responding to stress
Spiritual, religious, and/or philosophical investigations
Career passion, study projects, or art practices
Locating guidance
Relationship with money
Hydrating!
Alone time
Self-expression
Comforting + fulfilling hygeine rituals
Sense of authenticity in intimacy
Select any areas you feel concerned about or would like to see change in
*
Relationship to motion, exercise, physical strength
Sense of mental + emotional flexibility or spaciousness
"Work-life balance"
Sense of harmony with eating practices
Relationship with time (navigating deadlines, sense of ease, etc.)
Romance
Friendships + social time
Housekeeping/homemaking
Responding to stress
Spiritual, religious, and/or philosophical investigations
Career passion, study projects, or art practices
Locating guidance
Relationship with money
Hydrating!
Alone time
Self-Expression
Comforting + Fulfilling Hygeine Rituals
Sense of authenticity in intimacy
Which of these stand out as things you typically go through during an "off" day? What does a negative headspace look and feel like for you?
Select as many or few as you like!
Overheated, no matter what it's like outside
Cold and can't warm up
Biting back tears or sobbing
My emotions disappear and I can't feel anything
Secret Anger/Rage that I keep to myself
Despair
Intense tension in my muscles (clenching, knots, seizing)
Noticable changes to my posture (Curling inward)
Repetitive frustrustation, everything seems difficult
I get really quiet, and staying that way feels easiest
I get really talkative, and turning it down feels hard
It's hard for me to see the point in working on anything
My productivity level doesn't really change
I get into logical, detail-oriented arguments
I feel really lonely
I want to meet new people
I want to stay home and be left alone
I want a close friend to be with me
I end up yelling or saying things I don't mean to someone at some point
I can't stand still, I get really active or busy
It feels so hard to move and I feel half asleep
Food cravings
Less appetite
Headaches
I get focused on someone else's life story or how to solve or support a problem or project in another person's life
I want to read, watch movies, play music, write, or draw
Can't stand silence
Loud noises or extra background noise may push me over the edge
I get hyper-articulate
I can't explain what I'm thinking to people very well
I get a pain somewhere in my body and the cause is unclear
I want to see a doctor or therapist for help, if possible
I change my style
I typically end up smoking more, drinking more, or seeing if another drug can help switch up my headspace
I feel more focused on my spirituality than usual or focus on spiritual practices for help
I can't make sense of why i feel so bad
I don't understand how I ever feel good
I feel really dry (skin, mouth, or gut)
I have digestive issues or concerns
My skin gets inflamed
I feel more like myself in some ways
I can't recognize myself
it's hard to drink water
there's usually a deadline involved
i feel better quickly, more so than the people around me
What are some topics, fields, lenses, hobbies, or concepts you feel extra "fluent" in? What's one language that you love to speak?
*
Maybe you worked in a certain industry for years and the language from that world still influences how you read things. Maybe you have an interest or obsession that you can't help but pull words from on a daily basis. Maybe there's one single singer, writer, preacher, character in a book, or athlete that you feel specially fluent about. What are a few subjects you can understand and speak to "naturally," even when you feel crappy or tired?
If you could change or receive help with three things, what would they be?
Pick whatever time frame feels relevant. This week? This year? In your lifetime?
What are five descriptions you'd feel the most flattered to receive? Who would it feel best to hear describing you this way?
Try writing a few things that come to mind immediately, and then a few things that come to you after a moment of thinking about it.
Do you have any images that circle through your head once in a while of experiences, feelings, items, positions, achievements, or relationships you would like to have for yourself in your dream life?
Share anything that feels important to mention here. You can think about what you miss, envy, feel afraid of, or feel eager about for ideas.
Email
*
Phone
(###)
###
####