Thank you for applying! I look forward to learning about you!
On a scale of 1 -10 how happy are you with your life right now?
2 or below.
9 or 10
When it comes to your health, which area needs most attention, ( check all that apply).
Consistency and Self Discipline
Lack of motivation
How open and willing are you to improve your mental and physical wellbeing so you can experience more joy, feel lighter and THRIVE.
It sounds great, but the idea of added pressure and commitment is too much to think about.
I am tired of making excuses that keep me stuck, I’m open to new possibilities, I'm worth trying for.
Very open.I am aware that change is needed.
I’ve spiraled down and I could really use help, but I can't afford to do anything right now.
How committed are you to taking action in improving your mental and physical wellbeing?
I'm a creature of habit, and have a difficult time having others tell me what to do.
Change is uncomfortable for me, but I am open improving with smaller steps.
I am 100% committed to do whatever it takes and will take action on personal recommendations.
I am not open right now, even though I know I should be. Maybe down the road.
Hypnotherapy is different than coaching. How willing are you to apply what you will learn in our sessions and make effort to reinforce things at home.
Not really. I am already doing as much as I can right now, I don’t see how I can do anything else.
As long as it's not too much, I am already overloaded.
I'm very open, I need accountability and someone to tell me what to do.
I know what to do, I just need to make myself do it.
Right now I ...
don't have any financial resources and I will manage my mental and physical wellbeing.
have the resources to invest in my health, I'm open and exploring which options best suit me.
I am ready to take charge of my health and start a journey, it's time I focus on myself!
I'm curious about options, but I am not open at this time.
How bothered would you be if you did NOT take action to better manage your overall wellbeing.
I am fine. I can't imagine anything changing, I've tried everything already.
Very bothered, I’m sick and tired of feeling this way. I'm ready to feel good.
I have good days and bad days, I don't have much to complain about, I wish I felt happier.
Maybe I'm numb, but I’m too scared to try anything in case it makes me feel worse.
How willing are you to make simple DOABLE health habits knowing they will help to support your mood, health, work, and family.
I can’t even think about making any new habits right now, I’m so overwhelmed/shut down in life, it feels like pressure.
I am open to making simple daily shifts as long as they will help me feel healthier and happier.
I will do ANYTHING! I just need some accountability to make me do it. I’m not good at relying on myself.
I want to do everything I can do so I can get it over with and move on.
Which statement best describes your view about your commitments to yourself?
I bind myself as little as possible.
I make a commitment to myself only if I'm convinced that it really makes good sense to do it. Accountability is needed.
Once I make the decision, I take my commitments to myself as seriously as my commitments to other people.
Right now, making any commitments other than whats is already on my plate, feels very overwhelming.
When you’ve formed a healthy habit in the past, what helped you stick to it?
I'm all or nothing. If I decide to do something I do it.
I could stick to a good habit only when I was answerable to someone else.
Doing a lot of research and customization about why and how I might keep that habit.
I usually I don’t choose to bind myself in advance to a particular course of action.
There is often a connection between financial security, success and health habits. Describe your relationship with your finances?
I feel like I will never have the things I want in life.
I need to increase my income and am willing to do the work and discover how.
I’m in a healthy place financially.
I have no interest in investing in anything but what is essential or for my family or my business.
There is often a connection between relationship success, communication and your health habits. How would you best describe your personal relationship?
I feel like I will never have the relationship I desire.
I am open and willing to improve this area in my life.
I have great communication, ( most of the time). I’m in a healthy loving place with my partner.
I have no interest in improving this part of my life, it’s always disappointing.
Which description suits you best?
People get frustrated with me, because if they ask me to do something, I’m less likely to do it (even if they’re a boss or client).
Puts others—clients, family, neighbors, coworkers—first.
Disciplined—If someone tells me what to do, I do it, sometimes, even when it doesn’t make sense.
Refuses to be bossed by others.
Knowing that work and family take up time, are you willing to balance yourself with other things in life to bring you calm and joy?
There’s absolutely zero room in my life other than what’s required from me.
I feel out of balance and would love to find purpose or excitement in something other than work or home life.
I’ve been exploring this actually, but nothing seems to make sense so far.
I’ve tried too many things and nothing is a good fit. I'm done trying, and accept that this is my life for right now.
The mind and body work together, how much work or have you explored with Mindset?
I rely solely on medical doctors and science to tell me what I need to do.
I love this type of work, I’m a very spiritual person and I just need to get out of my own way.
I’ve tried therapy, but in all honesty I’m sick of my past and really want to focus on moving forward.
I’ve been to therapy, I’ve tried meditation, and nothing has worked. It's not for me.
Fueling your body with the right nutrition is an essential part of feeling healthy, both mentally and physically. How open are you to nutritional suggestions to ensure you are able to properly manage your blood sugar levels.
I have no interest in changing my diet, (unless my doctor suggests anything), otherwise, I'm fine.
I struggle with not enough during the day, sometimes too much at night, I would love any guidance with this.
I generally know how to eat healthy, but I struggle with cravings more often than I would like.
Nutrition feels too overwhelming to even think about, right now.
Exercise helps balance stress and elevates mood, not to mention all the other health benefits.
Not at all, I do plenty around the house, I'm fine.
I’m open to exercising, and I try to do it weekly, but I need accountability to make sure I do it.
As long as its simple and won’t take to much time, and I can make my own schedule.
I know its good for you, but the idea of exercise is as appealing as a root canal.
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This form was created inside of Rene Banuelos.