Realign with your purpose to live your ideal life!

This form will help you reflect on where you are, what's going well, and what you can do to realign with your purpose and take action.

You can print the form or keep it as a digital doc for yourself. 

You'll also help us get insight into what community members need help with. Don't worry; we'll not share your information with anyone else and completing the form doesn't mean you need to enrol in any of our services. 

This form is for you, to help you get back on track and find focus.

Sign in to Google to save your progress. Learn more
Email *
How do you truly feel about yourself NOW?
(The things you do, don't do, and your routine.) *
How do you feel about the direction you're going?
(The work you're taking on and the actions you take on a daily basis.) *
What have you already achieved?
(It can be big, small, and anything in between.) *
What did you want to achieve, but haven't (yet)? *
What do you keep postponing? Why? *
Use the scale to define how aligned you feel with your purpose. *
Not at all
100% aligned
Use the scale to define how on track you feel with your goals. 
 *
Not at all
100% on track
Identify what's stopping you from making progress.
(Think of problems, challenges, obstacles, fears, limiting beliefs, thoughts, past experiences, and even people or relationships that hinder you.) *
What is the number one goal you want to achieve this year? *
What or who do you need to stay aligned with your purpose?  *
What or who do you need to hold you accountable for taking action?
 *
By the end of this year, I want to feel...
 *
At the start of 2024, I want to do/feel/go...
 *
Use this space for any other reminders, things you'd like to take note of, or share.

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