Questionnaire
Please complete the following questionnaire prior to our session together…
First Name *
Last Name *
Email *
Phone Number *
Air *
1. I don’t do any breathing exercises
2. I do some kind of breathing exercises
3. Option2+ ventilated spaces
4. Option3+ diffuse essential oils to purify air
5. Option4+ 15min advanced pranayama breath work
Water *
1. I drink less than 500ml water a day
2. 1 Litre of water a day
3. Option2+ I have a water filter
4. 1 Litre of filtered/spring water per 22kg of body weight
5. Option4+ I super charge it to make it more alkaline & pure
Sunshine *
1. I don’t get any sunshine
2. I get 15min incidental sunshine
3. 2x15min sessions of sun/wk & use natural sunscreen
4. 2-4x15min sessions of sun/wk & use natural sunscreen
5. 5-6x15min sessions of sun/wk & use natural sunscreen + sun-gazing
Exercise *
1. I do not exercise at all
2. I walk at least 30min everyday
3. Option2+ yoga and stretching
4. Option3+ fun cardiovascular exercise 2x a week
5. Option4+ strong commitment plus maybe personal trainer
Wholefoods *
1. I don’t really eat any fruit and veg
2. 1-2 serves fruit&veg/day, aware processed foods & preservatives
3. Option2+ buy local/organic, 1 home cooked meal/wk
4. Option3+ mindful eating 3 home cooked meals/wk
5. Option4+ I listen to what works for my body. 80%+ wholefoods. 5 home plant based meals/wk
Passion *
1. I spend no time on my passion
2. I spend 1 -2 hours/week developing my passion
3. I spend time on my passion daily and I sometimes teach my passion
4. I have a 1-2year plan for your passion
5. I have a 10year plan on the legacy my passion will leave
Relationships *
1. I haven’t had a role model for what a good relationship looks like
2. I have a good relationship with myself with love & compassion
3. Option 2 + good relationship with 2 closest people in my life. Excellent communication and encouragement of each other.
4. Option 3 + really good relationship with everyone at work. Communication is clear. I’m not holding any grievances.
5. Option 4 + I regularly review and check in on the relationship with myself and with others. People come to me for relationship advice.
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