Is Chi for Me Survey

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Congratulations! You are taking THE FIRST STEP!

Is Chi for Me Survey begins the conversation and our connection. Once you’ve completed the responses, I will contact you to set up a 30-minute complimentary Discovery Call.

Please answer the question in a few sentences or less.

Is CHI For Me Survey is highly confidential and will be viewed solely by Sanna Carapellotti.

Email *

Full Name *

Phone *

Describe your stress or anxiety in one to three sentences. *

#1: What motivated you to complete this questionnaire today? Be specific. *

#2: What do you hope to achieve if you enroll in the partnership? *

#3: Why is this a good time to resolve the struggle you describe? *

#4: What else have you tried to resolve this issue? *

#5: Do you believe that childhood and generational influences still impact your life today? *

Yes

Other:

#6: Are you willing to explore the subconscious for hidden contributors to your stress? *

Yes

Other:

#7: How often do you follow a doctor or practitioner's recommendations? *

Most of the time

Sometimes I might

Changes are slim

Other:

#8: Have you ever been hospitalized for mental illness? *

#9: Are you taking medications for anxiety or depression or mental illness? *

Yes

#10: Have you ever been suicidal or attempted suicide? Explain. *

#11: What addictions do you have? Drugs, alcohol, medications, food, shopping, internet, porn? *

#12: Have you tried non-traditional healing methods for other issues in your life? If so, what have you tried? What are your thoughts? *

#13: How do you envision your life after the struggle is transformed? *

A copy of your responses will be emailed to the address you provided.

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