Connect with Your Chicago Life Coach Today

Awakening Wellness Coaching and Healing
Savita Laura Jachim, CWC, LMT,CYT,

Whole-Life Assessment - Questionnaire

Your Information

Name:*

Phone Contact:

Best Email:*

Birth Date:

Place:

Home Address:

Please answer the following questions Have fun with it; don’t take it too seriously, just simply write down what comes to mind. There is no right or wrong answers. Take a little time for yourself, get quiet and enjoy this process of going within. Your reflections will help us make the best use of our time together. If you do not have an answer then just skip that particular question.

Big or small, what are some of your hopes, dreams or desires for the next year and beyond? (physical, mental, emotional or spiritual)

What is weighing heavy on your heart or in your mind, stopping you from living beyond your current reality?

If you could do anything and your skills, qualifications or finances didn’t matter what would you do?

Is there anything you would like to achieve inwardly and outwardly within the next 6 months that would help you feel more fulfilled?

Today, is there anything to accomplish so at the end of your life, you can feel your life was well lived and have no regrets? (bucket list)

If you could speak to your future self a year from now what would you say to her or him?

Let yourself imagine, for a moment, you are writing a memoire’ about your life. What are the next few sentences you are writing? Use your imagination. No judgement, just write. (it can be from the beginning, the middle or the end of your memoire’)

Life is about progress not perfection. This next section gives us a wide angle view in 12 areas of your life wheel. Be honest and rate it from this present moment: (not from where you were or where you want to be)

Rank each from 0-10, 0 = being deeply unsatisfied, and 10 = being completely satisfied.

Work and career

Finances

Stress Mastery/Self Care

Relationships (family, friends, significant other)

Play, fun and recreation

Diet & Nutrition

Physical Care(exercise)

Self Esteem/ Emotional Wellness

Environment

Life Purpose

Spirituality

Creativity

I hope this brief assessment has sparked some curiosity to keep you moving forward. Grief, loss, change or any life transition are a part of the cycles of life. Unfortunately, unexpected events can pull the rug from under our feet and cause you to feel uncertain and at times stuck. If you are curious about moving forward and reclaiming your life or If you want dive in and access more peace, passion and purpose…Your next step: Complete assessment form and it will get sent to me. I will be in touch within 24 hours to set up your complimentary coaching session.

What is the best way to reach you email, phone, text?

What time zone are you in?

What is a good window of time to reach you?

Morning Midday Evening

I look forward to connecting with you so we can get to know one another.

Savita Laura Jachim.

awakening-wellness.com

Awaken from within.

“You have to grow from the inside out. None can teach you, none can make you spiritual. There is no other teacher but your own soul.” –Swami Vivekananda

Awakening Wellness Healing offers life coaching for women across Chicago.

Connect with Your Chicago Life Coach Today

Reach out now to begin your journey of growth and fulfillment.

Whole-Life Assessment - Questionnaire