Self-Assessment Questionnaire


This questionnaire will help you take a look at yourself.  Are you who you want to be?   Do not get hung up on not being able to answer a question 'yes' 100% of the time.  We are all in process...  An example of this would be eating habits.  Many of us choose to eat healthy whole food, but that does not mean we never eat something which is not.  The goal here is to feel more comfortable, not move into a place of shame and guilt for not being all that we can be.  Socialized habits take time to break.  Ease into changes and they may occur at a deeper level and be less resistant.  Don't be too hard on yourself.  Look inside and work toward getting your needs and desires met - one by one.  Desire is a natural expression of yourself.  It motivates growth and is necessary to becoming real.  


I make an effort to lead a healthy lifestyle

I know how to recognize a healthy whole food

I include nutritious and tasty food in my everyday meals

I drink plenty of clean water

I enjoy regular exercise

I practice deep breathing

I rest when my body wants to rest

I have plenty of energy to do the things I want to do

I am basically pain-free

I have enough money to enjoy myself

My finances are organized

I can comfortably afford my home

My home is clean and organized

I feel safe in my home

I accept and appreciate my body

I enjoy my sexual experiences

I have a place to go to be by myself

I enjoy sensual pleasure daily


I honor others and let them take care of themselves

I ask for help when I need it

I take time to relax

I am able to forgive myself and others

I manage my stress and anxiety

I bounce back quickly from feelings of depression

I feel in control of myself

I am interested in learning

I accept myself more and more all the time

I feel a sense of ease – comfortable in my own skin

I am confident when making decisions

I think that making my dreams come true is a possibility

I can recognize when I have the power to change something

I am able to accept when I cannot make a change

Soulful Living

I work at living in harmony with my environment

I have a deep respect for nature

I enjoy expressing my creative ideas

I spend time visualizing what I would like in the future

I ask for what I want

I am honest in my relationships with myself and others

I feel good about myself and what I do

I listen to my intuition

I trust and follow my instincts

I appreciate and enjoy natural living

I am aware of the synchronicities in my life

I feel serenity

I make a conscious effort to live in the present moment

I feel deep appreciation for who I am and all that I have

My dreams are coming true.......