Self-Reflection Questionnaire

Hey there!

I’m so glad you’re here. This self-reflection questionnaire is designed to help you explore your current thoughts, feelings, and experiences around body confidence, self-acceptance, and overall well-being.

We’re often told that changing our bodies is the key to confidence, happiness, and success—but what if you could feel that way right now, exactly as you are?

This isn’t just about answering questions—it’s about gaining insights into how societal messages have shaped your relationship with your body and how you can begin shifting your mindset to create the life you truly desire.

Take your time, be honest with yourself, and remember—there are no right or wrong answers.

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What do you believe would change in your life if your body looked different?
Example: “I’d feel more confident going out with friends, wearing certain clothes, and posting pictures without overthinking it.”   *
How often do you find yourself thinking about your body’s appearance? (Daily, Weekly, Occasionally, Rarely, Never)
Example: “Daily—I catch myself checking the mirror a lot, comparing myself to others, and feeling frustrated about how I look.”   *
Have you ever delayed or avoided doing something (wearing certain clothes, going to events, pursuing opportunities) because of how you felt about your body? If so, what?
Example: “Yes, I skipped going to the beach with my friends because I didn’t want to wear a swimsuit.”   *
What methods have you tried in the past to change your body’s appearance? Did they bring you lasting confidence or fulfillment?
Example: “I’ve tried restrictive dieting, but it just made me think about food even more. Any weight I lost came back, and I still didn’t feel confident.”   *
What do you believe is holding you back from feeling confident in your body as it is right now?
Example: “I worry about what others think of me, and I feel like I won’t be taken seriously unless I look a certain way.”   *
How do you currently cope with body-related stress or dissatisfaction?
Example: “I either avoid mirrors or obsess over changing my body through dieting or working out. Sometimes, I use food as a way to comfort myself.”   *

How important is it for you to feel joy and satisfaction in your daily life? (Scale from 1-10)
Example: “9 – I really want to feel more present and enjoy my life instead of being stuck in my head about how I look.”

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What does self-acceptance mean to you?
Example: “Being able to look in the mirror and not criticize myself. Feeling good in my body without needing to change it first.   *
If you could improve one aspect of your life that has nothing to do with your body’s appearance, what would it be?
Example: “I’d love to have more energy and focus to work on my creative projects without getting distracted by self-doubt.”   *
What kind of support or guidance would help you feel more at peace with your body?
Example: “I’d love to learn practical tools to shift my mindset, stop negative self-talk, and build a healthier relationship with food and movement.”   *

Next Steps

Would you like to schedule a 20-30 minute call to explore your answers and what’s next for you?

I completely understand that investing in yourself can feel both exciting and a little uncertain. We’ve been taught to believe that confidence comes after we change our bodies—but what if you could start feeling that confidence right now?

Let’s talk it through together. This call is a no-pressure way to:
✔ Get a feel for how we might work together
✔ See if this approach is the right fit for you
✔ Gain clarity on your next steps toward self-acceptance and confidence

If you’re interested, I’d love to support you on this journey.

P.S. Not ready to chat yet? That’s totally okay!
Even just filling out this questionnaire can give you valuable insights into your relationship with your body. Your answers will also help me better understand how to support you when the time feels right.

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