M.I.N.E. for Power In-Take Survey Thank you for your interest in the M.I.N.E. for Power program! I am delighted to work with you. Prior to our call, please complete this survey. I’ll use your responses to guide our conversation and explore how we can work together! Name * First Name Last Name Email * Phone * (###) ### #### Describe how you take care of yourself. * Think about the practices or rituals you leverage to recenter yourself. For example: Do you go to therapy? Do you create? Do you work out? What do you want to cultivate more of in your life? * What do you want to cultivate more of in your life? You can cultivate joy, self-love, peace, self-trust etc. Think about the feelings that bring you back to yourself after a trying day or battle. What do you want less of in your life? * What does a healed version of you look like? * Think about how she responds to conflict, rejection, how does she speak to herself? What does she do when negative thoughts creep in? I believe in a higher source * God, Lord, Jesus Christ, Buddha, Source, Divine, Beloved. Yes No It depends Self Efficacy Survey * I feel empowered to meet my needs. Strongly Disagree Disagree Neutral Agree Strongly Agree Other people are responsible for my happiness. Strongly Disagree Disagree Neutral Agree Strongly Agree I believe I am already liberated. Strongly Disagree Disagree Neutral Agree Strongly Agree I have a growth mindset. Strongly Disagree Disagree Neutral Agree Strongly Agree What obstacles keep you from walking in your liberated power? * Are you ready to make an investment in your healing to walk in your liberation starting in 2021? * Yes No Thank you!Please be sure to join me on Zoom during your scheduled appointment. For questions, email ayastrategiesgroup@gmail.com.
