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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.

Birthday

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?
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©2022 by Heal Within You

Disclaimer: I am not a licensed physician and the energy healing work provided on this website is not to be considered as a substitute for medical care. This information is not intended as medical advice and should not be used for medical diagnosis or treatment. Information provided here should not be considered a replacement for consultation with a healthcare professional. Any questions or concerns about your health should be directed to your physician . Energy healing supports the body’s own natural healing abilities, and is a valuable complement to conventional medical care, not a substitute for it.

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