New Year Questionnaire

new year vision creating questionnaire

Date *

* Indicates required field

Name *

First

Last

Email address *

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

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

Create your intention for this new year, as per my instructions ➡️ *

What do you see as your biggest blocks to achieving this intention? *

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 week or month to move you towards what you want? *

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

Where would you like to be by the end of the year? And don't be afraid to dream! *

Do you have specific things you'd like us to address on our call? *

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

Submit