Personalized Discovery Questionnaire

This questionnaire is designed for a genuine and profound self-exploration. Your thoughtful responses are a vital first step in shedding autopilot and will be invaluable in guiding you to cultivate surroundings that connect with your truest essence.

Before you start, let me know you name and contact e-mail address:

Name This field is required.

Email Address This field is required.

Phone Number (not obligatory)

Welcome to your journey of self-discovery! To begin, what is it you most wish for me to understand about you? This field is required. I am most happy when... This field is required. I feel most alive when... This field is required. What is most important to you? (Please focus on personal values, not family members.) This field is required. Which word runs like a red thread through your life? This field is required.

Describe Yourself in 5 Symbols

Click here for a simple guide on how to choose your five symbols.

Symbol 1 (upload an image and/or give a description/context)

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Symbol 2 (upload an image and/or give a description/context)

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Symbol 3 (upload an image and/or give a description/context)

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Symbol 4 (upload an image and/or give a description/context)

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Symbol 5 (upload an image and/or give a description/context)

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What would you like to be known for? This field is required. When was the last time a moment truly took your breath away? This field is required. An old paradigm or belief that no longer works for you is ... This field is required. How do you replenish your energy reserve and how often? This field is required. What would it take for you to believe in yourself down to your very toes? This field is required. Is there anything else you’d like to share that would help me understand the true essence of what you seek from this experience?

Website URL (leave this field blank)

Send a copy to me

Email Address (Change the address here if you want the copy sent to a different address)