AUSPICIOUS BEGINNINGS: Living Well Questionnaire

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Welcome to your EMBODIED WISDOM program!

EMBODIED WISDOM combines Life Coaching and Yoga Meditation Mentoring. Together, we will explore your innermost needs, desires, and gifts, through supportive coaching techniques, yoga philosophy, and embodied practices.

Designed for over-thinkers with often complex lives and deep yearnings, this container will provide you focus and guidance. It will help you devote sincere attention to your inner experience. You will learn diverse methods to regulate your nervous system, confirmed through Western science and time-tested yogic traditions. This is a rich opportunity to soothe the mind and elevate your view of what is possible. You can cultivate your deepest knowing and brightest being, to savor a deeper, happier, and impactful life.

Our journey together starts here! Your vast inner resources and dreams form the foundation of what you will create, with attentive and encouraging guidance by your side.

Please take some time to center yourself, get comfortable, and answer each question honestly and deeply. It generally takes 30 to 60 minutes to complete. This self-reflection is an important practice in and of itself, and a beautiful starting point for us to engage together. So, approach it as an opportunity to be explorative, intuitive, curious, and open!

Everything you share on this form and throughout our work together is treated with reverence, and will be kept strictly confidential. If you do not want to answer a question, simply mark n/a or some other indicator.

It is an honor to share this experience together.

With joy and excitement,

Virginia Hill

Email *

Name *

Today's Date *

YYYY

Phone

Texting Okay? *

Yes

Other:

Physical Address *

Mailing Address (If different) *

Date of Birth *

YYYY

Location and Time of Birth (optional)

Relationship Status *

Names of Important people and pets in your life (partner, kids [with ages], grandkids, parents, siblings, close friends, etc.): *

Why are you choosing to work with a Life Coach & Yoga Meditation Mentor? How can I be most helpful to you? *

What three goals would you like to accomplish within the next three months? *

What is one major goal you would like to accomplish within the next twelve months? *

How is your health? *

What are the problems or challenges you are facing now? *

What do you value most in your relationships? *

Do you use the Rituals for Living Dreambook & Planner, from Dragontree? *

Yes

If yes, for how long have you used the Dreambook & Planner?

What are your core values (if you know them) *

What are your top five gifts/strengths (if you know them)? *

What is your life purpose (if you know it) and what does living your life purpose look like to you? *

If you are not sure of your life purpose, what needs in the world are you moved to meet? *

Occupation (if applicable) or Family/Social Role(s) *

How well do your current roles fit (or not) with your purpose and natural strengths? *

Tell me about your vision for the future: *

How do you most want to FEEL: *

Do you feel confident in your ability to create whatever you want in your life? Why or why not? *

How is the quality of your sleep, and how many hours do you usually get? *

How do you feel about your body? *

How is your digestion? *

Are you comfortable sitting on the floor, squatting, and/or putting weight on your knees? *

Please share any injuries, surgeries, chronic conditions, discomforts, sensations, medications/supplements, or other details that influence physical practice. (We can always make individualized modifications, so you are comfortable and safe.) *

How would you rate your energy (without caffeine) on a 0 to 10 scale, with 0 means totally exhausted and 10 is full of energy? *

What do you do for relaxation? *

What major changes have taken place in your life in the last year? *

What do you consider your role to be in your local community? In your country? In the world? *

What do you enjoy doing in your free time? *

Do you exercise regularly? *

Yes

What do you do to move your body? *

What do you believe in? What guides your life? *

What do you do when you are really up against an obstacle or barrier?

What is your happiest memory? Be precise & savor! Where, how old, with whom, etc. *

What has been your greatest challenge, and how did you overcome it? *

What have been your greatest successes, and how did you attain them? Remember, these may include personal, creative, spiritual, or professional aspects - go deep & BE YOU! *

How willing are you to be uncomfortable? *

What lights you up and brings you the most joy? *

What do you consider to be the main losses or disappointments in your life? How do you respond to disappointment? *

What really makes you laugh? *

What motivates you or gives you energy (i.e. deadlines, affirmations, meditation, adrenaline, meditation, praise, travel, exercise, checklists, reading, rewards, etc.)? *

In the following sections, rate your self trust in the following areas, on a 0 to 10 scale (Total lack of trust = 1; Complete trust = 10)

COMMUNICATION: How much do you trust yourself to tell the truth, say what needs to be said for healthy relationships, speak kindly, & express yourself authentically?

DEPENDABILITY: How much do you trust yourself to show up for friends and family, and support them when they need it? *

FOLLOW THROUGH: How much do you trust yourself to follow through on your projects, in the time frame intended, to completion? *

FOCUS: How much do you trust yourself to stay focused on what you have chosen to work on and avoid indulging in distraction? *

MONEY: How much do you trust yourself to stay conscious of what you have, to maintain a positive attitude around money, and to avoid taking on unnecessary debt? *

HEALTH MAINTENANCE: How much do you trust yourself to treat your body and soul well, to get the care you need, and to be kind to yourself? *

NUTRITION: How much do you trust yourself to make good food choices, to eat in a healthy manner, and stick with your agreements around eating? *

WORK PERFORMANCE: How much do you trust yourself to honor the work you do, to do your best, and to show up enthusiastically? *

VALUES: How much do you trust yourself to live by your core values? *

EMOTIONS: How much does fear run your life [1 = not at all; 10 = completely]? *

If there were nothing holding you back, what would you do with your life? *

How do you feel about your connection to nature? *

How would you describe the spiritual dimension of your life? *

What is your FAVORITE thing about yourself? *

Take some time to highlight any key events that contributed to progress, pauses, and shifts in your life thus far, if they are not included in your responses above. *

How will you know our time together has been successful? *

Please share any additional comments or questions that are important to you. *

A copy of your responses will be emailed to the address you provided.

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