Simple Mapping Exercise

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Hello & Thank You for visiting this Simple Mapping Exercise.

This activity offers a combined list of things to check off and items to elaborate on. All of it is optional and intended to provoke your own thinking and potentially help you hone in on things you may want to work on together. Think of it as a running start. There are no right or wrong answers so try not to overthink it.

This activity is not in any way mandatory, nor does it provide any standardized profiling information. This is a simple template with common discussion items that can help us pinpoint what we might want to work on, also known as trailheads. There is also an open question for any comments or questions you think might better serve your particular needs. This and everything we discuss will remain confidential.

I look forward to the opportunity to help you launch yourself into your vibrant success!

Best,
TheresaWV

Email *

Name

Phone - *remains confidential*

Best way to be reached- * no spamming*

Phone

Either

Clear selection

Gender

Female

Male

Other:

Clear selection

Age

I would like to work on:

Committing to a healthy lifestyle

Understanding and categorizing my needs

Understanding and overcoming my success blockers

Setting Goals

Improving my relationship with myself

Relating to others successfully

Finding what works for me and flying with it!

Managing my stress

Changing my approach to my life so that I can get out of my own way.

Putting my happiness on my list of priorities.

Finding clarity about what matters to me most.

Communicating effectively with others.

Clear selection

What is my biggest obstacle?

I am

My lifestyle

Life demands

Someone else

Something else.

Clear selection

How happy would I rate myself as being in this moment that I am taking action.

Not happy

Somewhat unhappy

Neutral

Somewhat happy

Pretty Happy

Afraid

Not sure

Usually when I set my mind on something...

I get it done very quickly.

I find obstacles.

I get disappointed.

I self sabotage.

I take my time allowing for changes.

I let things happen. If it is meant to be it will be.

I used to be so focused.

I just don't know...it's time I get it together.

Clear selection

I consider myself to be an

Introvert

Extrovert

A little of both.

Clear selection

Choose sentences you most agree with;

I deserve to be happy.

I am fulfilling my dreams.

I feel proud of past accomplishments.

I am dedicated to getting clarity on my goals.

I am in tune with my body and immediately take care of its needs as they arise.

I connect on a deeper level with someone regularly.

I know I am capable of great things.

I have a clear definition of what success is to me.

I set goals and achieve them.

Others believe in me more than I do.

I feel stressed about my daily life.

I have recently experienced something traumatic.

I often feel anxious.

It's hard for me to accept a compliment.

I tend to want things my way.

I am hard on myself if things are not perfect.

I ruminate over mistakes.

I love being the center of attention.

I prefer team work to independent work.

I like to be in control.

Details annoy me.

I spend quiet time alone to clear my mind.

I spend hours on media and lose track of time.

I sleep 8 hours every or most night(s).

I watch what I eat.

I am often indecisive.

I don't believe in myself as much as I should.

I feel like I don't deserve to succeed.

A past failure still haunts me.

I can easily self motivate.

I am afraid of failure.

I fear success.

I am physically active.

I fear being criticised.

I enjoy hobbies.

I can be very sarcastic at times.

I watch TV every day.

I read to escape.

I enjoy personal development and learning.

I expect more of myself.

Humor is important to me.

I hold others to the same standards I hold myself.

I often feel "less than."

Being as healthy as I can be is a priority.

yes

not something I really think about

yes but I can't seem to stick with it.

Clear selection

Do you enjoy meditation/mindfulness activities?

Yes

Maybe

Clear selection

What is the activity you most enjoy and get lost in? How often do you do this?

Do you have unused memberships to health facilities/classes/apps?

Yes

Clear selection

Do you prefer to exercise with friends, strangers, or solo?

Friends keep me motivated.

Strangers: I like to see others exercising but socializing should be optional.

I prefer to maximize my alone time.

I am embarrassed to work out in public.

Clear selection

I consider healthy eating a priority.

Definitely! I know how to fuel my body

Generally

I know what I should be doing but I don't always do it.

Food? I eat when I can. After all I do I deserve a good meal.

Clear selection

Think about the last week of meals. Do you typically eat out (count anything you do not cook)

1-2X a week

3-5x a week

7x a week or more

hardly ever

Clear selection

What is your current fitness PRACTICE. How often do you engage in any form of exercise?

1-2x per week

3-5x per week

I do something just about every day

Not really.

Clear selection

My favorite physical activities are:

walking

running

cycling

fitness class at a gym

home fitness

yoga

dance

barre

sports (for example kick boxing, basketball, volleyball, soccer)

What are your health goals?

What has been your biggest barrier to self care?

Is weight loss a goal?

Yes

Maybe

Clear selection

When were you most satisfied with yourself / your life?

If I could choose anything and everything to make my life perfect I would pick...

My greatest fear is that...

If I were to become my friend, qualities I would appreciate most would be...

When it comes to self sabotage I usually...

If I could be someone famous I would pick... because...

If I were my parent I would say that the child version of me is...

One thing I regret most in my life is...

The greatest thing I want to change in my life right now is...

I understand this is a coaching service that is not a replacement for therapy or medical treatment. I also understand that although results can be extraordinary and fast, they differ from person to person. If at any time I decide to stop, I can get a refund for unused prepaid sessions. If my coach feels this is not a good match, she will issue a refund for unused prepaid sessions. Please sign full name below.

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

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