First Name
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Email
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I would like to attend the "Are You on the Verge of a Breakthrough Workshop"
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Yes
No
1. When you face a setback, what’s your first response?
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I pause, reflect, and remind myself it’s temporary
I feel frustrated but eventually refocus on solutions.
I struggle to move forward but try to stay hopeful
How often do you notice small moments of joy in your day?
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Every day—I’ve trained myself to see them.
Sometimes—it depends on how busy I am.
Rarely—I’m working on slowing down to notice them more.
How do you handle self-doubt?
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I remind myself of times I’ve overcome similar feelings.
I acknowledge it but don’t let it stop me from moving forward.
I often feel stuck but try to give myself grace.
When reflecting on your past self from a year ago, how do you feel?
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Proud—I’ve grown so much.
Grateful for everything I’ve learned.
Surprised—I didn’t realize how far I’ve come.
How do you respond to feelings of overwhelm?
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I take small, manageable steps forward.
I allow myself to rest and reset.
I often feel paralyzed but try to push through.
How often do you celebrate your wins, big or small?
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Regularly—I make it a point to celebrate.
Sometimes—I’m trying to get better at this.
Rarely—I tend to focus on what’s next.
What’s your relationship with self-compassion like?
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I’m kind to myself, even on tough days.
I’m learning to speak to myself like I would a friend.
I’m critical but trying to change.
How do you view challenges in your life?
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As opportunities for growth.
As part of the process, even if they’re tough.
As obstacles I try to overcome one at a time.
When someone gives you a compliment or acknowledges your growth, how do you respond?
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I accept it with gratitude.
I smile and let it sink in.
I struggle to believe it but want to get better at receiving.
How do you feel about where you are in your journey right now?
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Content—I trust the timing of my life.
Motivated—I know I’m on the right path.
Hopeful—I’m open to what’s next.