Full Name

Phone *

Email *

How would you rate your current self-love journey? *

I feel disconnected from myself and often struggle with self-worth.

I’m making progress, but I still have unresolved issues that hold me back.

I feel confident in some areas, but I want to deepen my self-love practice.

Do you often prioritize others’ needs over your own, leaving yourself drained and unfulfilled? *

Yes, I often feel this way.

Sometimes, but I try to balance.

Rarely, I prioritize myself.

Do you struggle with forgiving yourself or letting go of past mistakes? *

Yes, it’s hard to let go.

I’m working on it, but it’s tough.

No, I’ve moved past most of it.

Are you looking to strengthen your boundaries and enhance your relationships through self-love? *

Yes, I need stronger boundaries.

I want to feel more confident in relationships.

Both!

What is your biggest challenge when it comes to self-love? *

Negative self-talk and self-doubt.

Balancing self-care with responsibilities.

Building meaningful relationships while staying true to myself.

How soon are you ready to take action on your self-love journey? *

Right now! I’ve been waiting for the right opportunity.

n the next few weeks—I’m ready to commit soon.

I’m exploring options but need more guidance.

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