Date * MM DD YYYY Name * First Name Last Name Email * Number Social Media Handle Survey * Please answer this brief survey. I have a spiritual practice that keeps me balanced and inspired. Strongly Disagree Disagree Neutral Agree Strongly Agree I engage in physical activity ( strength training, dance, yoga, sports, or power walking) at least 3 times a week. Strongly Disagree Disagree Neutral Agree Strongly Agree I receive restorative treatments at least once a month (massages, reiki, facials, mani/pedis, saunas etc.) Strongly Disagree Disagree Neutral Agree Strongly Agree I have an established self-care routine/ritual. Strongly Disagree Disagree Neutral Agree Strongly Agree I am part of a support group, have a therapist or have an uplifting social circle. Strongly Disagree Disagree Neutral Agree Strongly Agree Thank you!
