Ziva Life Collective Questionnaire

Please allow 15 minutes or more to answer these questions.

Ziva Life Collective

First Name

Last Name

Phone

Address

City

State

Post Code

Country

Do you have any food allergies that we should know of?

How old are you?

How old do you feel?

What is your profession?

Do you love what you do and Why? If you don’t love it, why?

On a scale of 1 – 10, how much do you love yourself right now?-

On a scale of 1 – 10 how would you rate the current state, power and control of your - Mindset (how you think)?

On a scale of 1 – 10 how would you rate the current state, power and control of your - Heartset (how you love)?

On a scale of 1 – 10 how would you rate the current state, power and control of your - Healthset (your strength and vitality)?

On a scale of 1 – 10 how would you rate the current state, power and control of your - Soulset (your connection with spirit)?

What are the dominant emotions you experience in your day to day?

What lights you up about what you currently do day to day?

What are your darkest fears?

Do you feel there are gaps in your life design? Where do you see your current gaps?

What do you find a struggle?

Who is the person you dream of becoming? What does this new version of feel like?

What are your greatest desires?

As you picture yourself at the end of this year, how would you like your life to be different?

Have you ever had a coach / mentor before?

Yes

Who was your coach / coaches? In what areas were you coached?

What are 3 emotions that you would like to leave the Ziva Life Collective Retreat experiencing?

If you are human, leave this field blank.

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