Well Balanced Center Application
Welcome! This is your introduction to what we will accomplish together and allow us to get to know you a bit.
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Doing this intake process is a way for us to understand who you are at your core, what's most important to you and what you want to accomplish by engaging in our program. Feel free to simply answer the questions and be as honest with yourself as possible. We want to learn what fires you up. This will take about 20 minutes. Only two people will review your answers, the WBC Director and the WBC Lead Coach, your results will not be shared.
1. Please share your first and last name *
2. Best email address that you check on a regular basis: *
3. How or from whom did you learn about this program? *
4. In a couple paragraphs, we would like to get to know you a bit better, please summarize your life from birth to age 18, where you lived, who was around you, anything that provides insight into who you are today. *
5. City and state or country where you currently live *
6. If you were to ask a close friend to describe you in a paragraph, what do you think they would say? *
7. Please copy and past the link into your online search engine, take the quiz and let us know if you have a growth or fixed mindset: https://www.idrlabs.com/growth-mindset-fixed-mindset/test.php *
8. If you bumped into an old friend from high school, how would you describe what you've been up to? *
9. What books/magazines/blogs/shows or movies do you watch/love? You can just list the first few that come to mind. *
10. How much attention are you able you devote to managing your stress in a usual 24 hour period? *
11. List up to four activities you have used to manage your stress: *
12. How much time do you spend by yourself during an average day? *
13. What percentage of the time you spend by yourself do you enjoy? *
14. Take a few minutes to think about what is holding you back; my life would be easier if... What do you think is preventing you from getting what you want out of life right now? *
15. How have you invested in yourself in the past? Please list books, blogs, courses, seminars, conferences, therapy, coaching? Please list the first few things that come to mind. *
16. What keeps you up at night and or share a few examples of the worries in your mind? *
17. What would happen if you don't make progress in the area of your life that you would like to change? *
18. What would you like to see happen if you committed an hour or two a week engaging in our program? *
19. What is going well in your life? *
20. What do you believe you are really good at? What would a family member or good friend say you are really good at? *
21. What physical activities did you enjoy when you were under 18? What do you enjoy doing now? *
22. How would you rate your close relationships with the key people in your life? *
I have a lot of painful relationships in my life
I get along well and have close relationships
23. If you could accomplish a few realistic things that would light you up, what would they be?   *
24. When is the last time you were really proud of yourself and what was the accomplishment? *
25. What are some ways you get in your own way? *
Required
26. Are you 18+ and thus able to consent to some material on the Well Balanced Center website/experience that may occasionally have mature content and are you up for spending an hour or so a week to focus on yourself? *
27. How would you like to be remembered/what impact do you hope to leave behind? *
28. Anything else that we should know before you potentially jump into this program? *
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