Monthly Questionnaire

Deep Healing and Graduate Programs

Monthly Questionnaire

Date *

Name *

First

Last

Email address *

Briefly describe how you feel about your life right now: *

One a scale of 1 to 10 (10 being the highest,) how good do you feel about your life? *

Do you see any improvements in your family life from last month? *

What are the biggest challenges you are experiencing in your family or in your life in general? *

What would you need to do to address the challenges above? *

What are at least 3 cross-off-able actions you can take in the next 2 weeks to move you towards what you want? *

What would you like to focus on for the next month? *

Where would you like to be by this time next month? *

What would you like us to address on our next call? *

Is there anything else you'd like to share? *

Submit

"There is no single effort more radical in its potential for saving the world than a transformation of the way we raise our children."

Marianne Williamson

Parenting For Wholeness

What Eliane's Clients Have To Say:

﻿Parenting For Wholeness﻿

﻿What Eliane's Clients Have To Say:﻿

Parenting For Wholeness

What Eliane's Clients Have To Say: