Personal Reset and Realignment Survey
Reflect on your current state, assess key life areas, and set intentions for realignment and growth.
Full Name
First Name
Last Name
Email Address (for follow-up or results, if desired)
example@example.com
How satisfied are you with the following areas of your life?
*
Rows
Very Dissatisfied
Dissatisfied
Neutral
Satisfied
Very Satisfied
Physical Health
1
2
3
4
5
Emotional Wellbeing
6
7
8
9
10
Relationships
11
12
13
14
15
Career/Work
16
17
18
19
20
Personal Growth
21
22
23
24
25
Finances
26
27
28
29
30
Work-Life Balance
31
32
33
34
35
Which area do you feel needs the most attention right now?
*
Physical Health
Emotional Wellbeing
Relationships
Career/Work
Personal Growth
Finances
Work-Life Balance
Other
What challenges or obstacles are currently holding you back from feeling aligned in this area?
*
What is one value or principle you want to prioritize during your reset?
*
On a scale of 1 to 10, how motivated are you to make positive changes in your life right now?
*
Not motivated
1
2
3
4
5
6
7
8
9
Extremely motivated
10
1 is Not motivated, 10 is Extremely motivated
What is one action you can take in the next week to move toward realignment?
*
What support or resources would help you stay on track?
Please rate your overall sense of alignment with your life goals at this moment.
*
1
2
3
4
5
Would you like to receive a summary of your responses or additional resources?
Yes, please email me a summary/resources
No, thank you
Submit Survey
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