Flow, Grace & Abundance – Intake Form | The Art of Heartful Living

Notate how well the following statements apply to you by choosing the number that most fits you, with 1 being not true at all, and 10 being very true. After filling out the Intake Form click submit.

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1. My relationships with family, friends and romantic partners are relaxed, connected and free of stress.(required)

2. I never experience myself stuck in negative patterns in my relationships, school, work and general well-being.(required)

3. I have a high degree of awareness around when I get triggered and find myself in a dysfunctional, stuck state of fight, flight or freeze.(required)

4. I am very focused, productive, confident and stress-free with my work and life in general.(required)

5. I feel optimistic and hopeful about my future and my capacity to address challenges in my life.(required)

6. I am always in a state of flow, grace and harmony inside myself and with life around me.(required)

7. I never find myself being thrown off balance emotionally by other people, events, and circumstances.(required)

8. I never feel stressed, overwhelmed, hyperalert and/or anxious in my life.(required)

9. I feel very present, connected and in the flow with my life.(required)

10. When I feel threatened or when someone challenges me, I never feel a strong urge to attack, suppress and/or do away with whatever is threatening me.(required)

11. When I feel threatened or when someone challenges me, I never feel a strong urge to run and/or get as far away from what is threatening me as possible.(required)

12. When I feel threatened or when someone challenges me, I never freeze and disassociate from whatever is threatening me.(required)

13. I find it easy to relax, breath deeply and let go of stress.(required)

14. I never find my mind overactive, ruminating about what is stressing me and/or is making me feel challenged, threatened or uncomfortable.(required)

15. I experience a high level of joy and well-being in my life.(required)

16. I manifest overflowing abundance in my life from a state of flow and grace.(required)

17. What do you hope to get out of your experience in this course?(required)

18. How much time do you spend doing the following activities on an average day (sleep, meditation, exercise, play, work, time with friends & family, computer/mobile device usage)? (required)

19. Are you currently taking any medications, recreational drugs or dietary supplements? Please describe.(required)

20. Are you currently receiving therapy to address any physical, emotional, mental and/or spiritual issues? Please describe.(required)

21. What causes you to feel stressed, overwhelmed, exhausted, and/or fearful in your life?(required)

22. What supports you in feeling a state of flow, harmony and well-being in life?(required)

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