Inspired Lifestyle Questionnaire
Thanks so much for choosing to work with IHD. Please submit the following survey. The more clarity you can provide, the better I will be able to identify strong solutions.
Email address *
I have great nutritional habits.
Not True
GREAT!
I sleep like a baby every night.
Never
Always
Rate your activity level.
Completely Sedentary
Very Active
I exercise every day.
Never
Always
I feel overwhelmed.
Always
Never
I feel anxious.
Always
Never
I am intentional about when and how I check and respond to email and social media.
No, its very random and impulsive
Yes, I have rigidly defined habits
I feel in control of my own life and empowered to chase my goals.
Not at all
Very
Financial priorities, habits, and values are clearly defined for myself and my household.
Not at all
Very
My family always eats dinner together.
Never
Always
I always prepare my own breakfast and lunch.
Never
Always
I find managing my children's affairs to be a full time job.
Absolutely
Not at all
My children are appropriately responsible for their age.
Not at all
Exceptionally so
My children are appropriately autonomous.
Not at All
Exceptionally so
My children display exceptional discipline and willpower.
Not at all
Exceptional
Expectations, Responsibilities, and Values are clearly defined in my household.
Not at all
Exceptionally so
I am more likely to praise my children for:
I think our society's norms in regard to youth development are healthy and appropriate.
Not at all
Absolutely
I believe that I am always the greatest determinant of my own success or failure.
Not at all
Absolutely
My family has taken steps to limit the pervasiveness of technology
Not at all
Absolutely
What is the greatest source of dissatisfaction in your life?
Your answer
What is your reaction to this concept: "Victim Mentality"
Your answer
What is your reaction to this concept: "Learned Helplessness"
Your answer
Describe your beliefs in relation to "work/life" balance. *
Your answer
Describe your beliefs in relation to turning people down and/or saying "no" to invitations and requests. *
Your answer
What does the best possible outcome of this consultation look like? What do you hope to accomplish? *
Your answer
A copy of your responses will be emailed to the address you provided.
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