Questionnaire

Take a deep, long breath.
You’re about to begin the journey to living the best life you can. You must actually do the work to see the results, and that work, begins now. As you fill out this questionnaire, be open, honest, and authentic. All of the questions are optional, but the more information you provide, the greater the results will be. Here we go..

***Meditation

Premise: Meditation has scientifically been proven to have a positive impact on mood, to lessen anxiety, and to improve depression.
  1. Have you ever meditated?
  2. If you have never meditated, would you be open to spending 5 minutes per day in the morning, and 5 minutes per day in the evening?
  3. If you have meditated, do you currently have a regular practice? If so, how often do you meditate? Have you noticed a positive impact?

***Exercise

Premise: Exercise (even moderate) can have a very beneficial impact on your mind, and on your body.
  1. Do you currently exercise? If so, how many times per week, and for what duration? How do you feel immediately after you exercise?
  2. If you don’t currently exercise, would you be willing to begin with 15 minutes per day? 30 minutes per day?

***Therapy/Counseling

Premise: Therapy and counseling can provide a safe environment for you to explore your past, present, and future.
  1. Have you ever been in therapy? If so, when, for how long, and for what reason? How was your relationship with the therapist? Was it effective for you?
  2. If you have not ever been in therapy, do you have any beliefs about therapy? Do you feel any stigma associated with therapy?

***Diet

Premise: The type of foods you eat, and the quantity of food you eat, can have a dramatic impact on your mood.
  1. Do you think well? More specifically, would you characterize yourself as a person who lives to eat, who eats to live, or a little of both?
  2. How is your energy level during the day? If it decreases, what time of day does this occur?
  3. In the past 12 months, have your changed your diet at all with the intention of improving your mood?

***Contemplative Study / Philosophy

Premise: Socrates said, “The un-examined life is not worth living.” By taking time to reflect upon your life, in a structured manner, you can gain clarity around your purpose, and ultimately, your happiness.
  1. How much time do you spend each month (if any) studying philosophy?
  2. How much time each month do you spend (if any) reflecting upon your own life, your purpose, and your happiness?
  3. If you don’t spend any time, would you be willing to spend 30 minutes per month studying different aspects of philosophy and what generations before us have relied upon to find purpose and happiness?

***Religion/Faith

Premise: Religion can be a polarizing topic; and, at the same time, religion can help provide purpose and make the challenges of life more tolerable.
  1. Are you active in organized, religious activities? If so, how often? And do these activities bring you comfort?

***Journaling

Premise: Many disciplines implement journaling as a way of tracking, documenting, and organizing life.
  1. Do you currently journal? If so, how often?
  2. What (if any) journaling have you done in your life … all the way to your childhood and keeping a diary?
  3. Have you found journaling helpful?

***Reading

Premise: Reading can be a source of expanding one’s metaphorical horizon.
  1. What are the top 5 books you have read, in terms of spirituality, purpose, or the pursuit of happiness?

***Medicine

  1. 
Are you currently on any medicine to help treat anxiety and/or depression? If so, for how long have you been on the medicine? Do you believe it helps?
  2. Have you ever been on medicine in the past? If so, for how long had you been on the medicine? Do you believe it helped?
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