Pre-Glow Questionnaire

GLOW Program Participant Questionnaire

Introduction

Welcome to the GLOW Program! This questionnaire will help me understand where you’re currently at in various aspects of your life. Please take a few minutes to answer the following questions honestly. Your responses are confidential and will guide me in tailoring the program to your needs.

First name

Last name

Phone

Birthday

Month

Day

Year

Self-Assessment

Rate yourself on a scale from 1 to 10 (1 = Needs Improvement, 10 = Thriving).

Health and Wellness How would you rate your current health and wellness?

Relationships with your partner (if applicable):

Relationships with your friends

Relationships with your family

Career and Professional Growth-- How satisfied are you with your career or professional growth?

Clarity and Direction-- How clear are you about your personal goals and direction in life?

Self-Love and Self-Worth-- How would you rate your level of self-love?

Self-Love and Self-Worth-- How would you rate your sense of self-worth?

Overall Joy and Fun-- How much joy and fun do you experience in your daily life?

Feminine Energy-- How in touch do you feel with your feminine energy?

Feminine Energy-- How in touch are you with your sensuality?

What is your biggest goal or intention for participating in the GLOW program?

Are there specific areas where you’re seeking support or guidance?

What makes you feel the most feminine?

Can you describe what it feels like to be in your feminine energy?

Is there anything else you’d like me to know about you?