Spiral Questionnaire
Hello Brave One,

I’m thoroughly excited to be taking you through The Spiral.

In order for the ride to be as deeply transformative and powerful as possible, please fill out the form below.

May the energy begin to swirl,

Belinda
x

Name / Age
Your answer
Email
Your answer
Occupation
Your answer
What 3 things do you want more of in your life?
Your answer
What 3 things do you want less of?
Your answer
What is the greatest issue or challenge you are currently experiencing?
Your answer
How long have you been struggling with this issue? And what have you tried in order to overcome it?
Your answer
What is the cost of having this issue? As in, how has it impacted your life and who you are.
Your answer
How do you feel when you think about those issues and where you are in life?
Your answer
What internal changes are you hoping to make by participating in Spiral?
Your answer
What other spiritual, self development or therapies have you done in the past?
Your answer
Are you currently seeing any other mental health or spiritual practitioners? If so please specify
Your answer
Have you ever been professionally diagnosed with mental illness?
Your answer
Are you currently taking any prescription or recreational drugs? Please specify what and how often?
Your answer
Have you experienced trauma in your past?
If yes, which type?
Are you currently or have you been suicidal in the past?
Is there anyone in your life who actively opposes, antagonises or suppresses you?
Your answer
What is the most important change you would like to experience within yourself?
Your answer
My ACES test number is:
Your answer
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