JoyReform Dinners - Pilot Program

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Once you’ve completed this application, you’ll receive an on-boarding call from Barbara within the next two days. Please provide a valid email address and phone number. Let's get started!

Email *

Phone number *

How do you feel when you first wake up in the morning?

I lie there exhausted, unable to move.

I'm tired - who isn't? I can usually get myself to the coffee machine and then I'm OK.

I don't have time to feel. I'm probably already up and out and about, working through my to-do-list.

I'm mostly rested and ready for the day.

Clear selection

How do you feel about your work?

I'm happy with what I'm doing. I have bad days here and then, but that's human and I tend to try and get support from other people when I need it.

I find myself looking at others, finding that they seem to be happier.

I feel like I'm just coping - there's always so much to do.

I'm usually on top of most things. I get the occasional insecurity, but I can usually rise to the occasion.

Clear selection

Think about a specific task that you've procrastinated on recently. When you think about doing this task, the first thing that comes to mind is:

Is this even possible?

If I had to choose between this and taxes, I choose taxes.

What’s the point? I’m not getting anything out of this.

Hey, look, a shiny thing! What were you saying?

Clear selection

When you're out for a walk, where does your mind go?

I'm just happy to be outside. Sometimes I even smile at people I don't know who are also out for the day.

I'm pretty drained. I have to order myself to keep moving and not quit.

I get lost in daydreams about all the things I have to do.

I tend to just let my mind wander - it'll go wherever it needs to go.

Clear selection

What did you do last weekend?

I spent time with a friend of mine who needed support.

I worked from Friday to Sunday.

I spent time with family and friends, ran some errands, straightened up the house; I felt really busy.

It was a mix of socializing and downtime.

Clear selection

How's your physical health?

I have a lot of aches and pains, colds, minor infections or stomach upsets.

I'm tired all the time. I don't know what it's like to not be tired.

I feel okay, but I know I need to work out more frequently and get more sleep.

Mostly OK. I get the occasional cold/problem, but I'm good.

Clear selection

When you think about the life of your dreams, how close does your current life come?

Who thinks about that stuff? My life is what it is and I can't do much to change it.

I'm probably not as close to my perfect life as others are, but I'm always working on it.

To the outside world and on paper my life looks perfect. It seems like everything I've ever wanted, but honestly, I'm not sure anymore.

I'm working on it and I'm OK with that.

Clear selection

Right before you fall asleep, what are you usually thinking about?

Everything that went on today and if I did everything right.

How tired and overwhelmed I feel.

What I did and didn't do today - and what I have to do tomorrow.

What a great day I've had and what the plans are for tomorrow.

Clear selection

I'd like to join JoyReform Dinners to... *

Every accomplishment starts with the decision to try and I thank you for taking this survey and the time to dig a little deeper. Digging deep doesn’t just mean going the distance, or exploring — it’s a loving space you hold, and a willingness to not settle. Let's explore this together and match you with a fantastic group of supportive people - just like you. Talk soon! Barbara

To learn more, visit https://message4barb.wixsite.com/joy-reform

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms