Personal Empowerment Assessment

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Section 1 – Your Details

Name

Phone

Section 2 – Self-Assessment Questionnaire

1. Do you have existing pain points?

Yes

Not Sure

Clear selection

Short Note (optional)

2. Do you feel stagnated in mind, body, and spirit?

Short Note (optional)

3. Would you like to activate your true identity?

Short Note (optional)

4. Are you presently employed in an occupation you have passion for?

Yes

Clear selection

Short Note (optional)

5. Do you live the P3 Theory of Passion / Purpose / Possibility Lifestyle?

Yes

Not Sure

Clear selection

Short Note (optional)

6. Do you feel you’re living in balance?

Yes

Not Sure

Clear selection

Short Note (optional)

7. Are you living in imbalance with organized chaos?

Short Note (optional)

8. Are you existing in a safe place — your comfort zone?

Short Note (optional)

9. Are you living with poor time management habits?

Short Note (optional)

10. Are toxic people and toxic environments sabotaging you?

Short Note (optional)

Section 3 – Closing Reflection

What specific action will you take this week to begin activating balance in your life?

Section 4 – Final Question

Would you like assistance or a coach?

Submit

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