Name :[text* text-972 placeholder "Enter Your Name"] Email :[email* email-29 placeholder "Enter Your Email"] How did you hear about us? [text* text-494 placeholder "How did you hear about us?"] Phone :[tel* tel-44 placeholder "Enter Your Mobile No."] Your time zone?
[select* menu-536 "Eastern" "Central" "Pacific" "Europe" "Asia"]

Step 1 : Finding Your Centers

A. Do you ONLY feel good when you are around other people?
[radio radio-899 use_label_element "Yes" "No"]
B. Do you spend most of your time doing what other people want?
[radio radio-818 use_label_element "Yes" "No"]
C. Are you doing what you really want to do?
[radio radio-819 use_label_element "Yes" "No"]
D. Are you afraid to share what is really on your mind?
[radio radio-820 use_label_element "Yes" "No"]

Step 2 : Locating Your Zones

On a scale of 1 to 5, mark the following statements for each of these three categories:
1 being never and 5 being all of the time.
A. With your boss
B. With family and those you love
C. With your peers.

1. I am in touch with and feel satisfied expressing my emotions and feelings in calm peaceful ways?
A. With Your Boss
[radio radio-610 use_label_element "1" "2" "3" "4" "5"]
B. With family and those you love
[radio radio-531 use_label_element "1" "2" "3" "4" "5"]
C. With your peers
[radio radio-532 use_label_element "1" "2" "3" "4" "5"]
[calculated calculated-621 "radio-610+radio-531+radio-532"] 2. I can be myself in all situations?
A. With Your Boss
[radio radio-533 use_label_element "1" "2" "3" "4" "5"]
B. With family and those you love
[radio radio-534 use_label_element "1" "2" "3" "4" "5"]
C. With your peers
[radio radio-535 use_label_element "1" "2" "3" "4" "5"]
[calculated secondquestion "radio-533+radio-534+radio-535"] 3. I have the courage to speak my truth in all situations?
A. With Your Boss
[radio radio-536 use_label_element "1" "2" "3" "4" "5"]
B. With family and those you love
[radio radio-537 use_label_element "1" "2" "3" "4" "5"]
C. With your peers
[radio radio-538 use_label_element "1" "2" "3" "4" "5"]
[calculated thirdquestion "radio-536+radio-537+radio-538"] 4. My relationships are rich, satisfying and fulfilling?
A. With Your Boss
[radio radio-539 use_label_element "1" "2" "3" "4" "5"]
B. With family and those you love
[radio radio-540 use_label_element "1" "2" "3" "4" "5"]
C. With your peers
[radio radio-541 use_label_element "1" "2" "3" "4" "5"]
[calculated fourthquestion "radio-539+radio-540+radio-541"] 5. I have a career that I can brag about?
A. With Your Boss
[radio radio-542 use_label_element "1" "2" "3" "4" "5"]
B. With family and those you love
[radio radio-543 use_label_element "1" "2" "3" "4" "5"]
C. With your peers
[radio radio-544 use_label_element "1" "2" "3" "4" "5"]
[calculated fifthquestion "radio-542+radio-543+radio-544"] 6. I am comfortable in my own skin?
A. With Your Boss
[radio radio-545 use_label_element "1" "2" "3" "4" "5"]
B. With family and those you love
[radio radio-546 use_label_element "1" "2" "3" "4" "5"]
C. With your peers
[radio radio-547 use_label_element "1" "2" "3" "4" "5"]
[calculated sixthquestion "radio-545+radio-546+radio-547"] 7. I don’t blame, judge or criticize others?
A. With Your Boss
[radio radio-548 use_label_element "1" "2" "3" "4" "5"]
B. With family and those you love
[radio radio-549 use_label_element "1" "2" "3" "4" "5"]
C. With your peers
[radio radio-550 use_label_element "1" "2" "3" "4" "5"]
[calculated seventhquestion "radio-548+radio-549+radio-550"] 8. I can resolve conflicts in healthy ways where both parties are better off?
A. With Your Boss
[radio radio-551 use_label_element "1" "2" "3" "4" "5"]
B. With family and those you love
[radio radio-552 use_label_element "1" "2" "3" "4" "5"]
C. With your peers
[radio radio-553 use_label_element "1" "2" "3" "4" "5"]
[calculated eighthquestion "radio-551+radio-552+radio-553"] 9. I can get out of revolving trauma from past issues so my energy is not drained?
A. With Your Boss
[radio radio-554 use_label_element "1" "2" "3" "4" "5"]
B. With family and those you love
[radio radio-555 use_label_element "1" "2" "3" "4" "5"]
C. With your peers
[radio radio-556 use_label_element "1" "2" "3" "4" "5"]
[calculated ninthquestion "radio-554+radio-555+radio-556"]

Step 3 : Targeting Your Actions

Below is a series of statements or questions. Do you find yourself saying or thinking these?
Answer Yes or No.

A. Why can't I make it happen for me?
[radio radio-425 use_label_element "Yes " "No"]
B. "They" won't let me...
[radio radio-426 use_label_element "Yes " "No"]
C. No way! I can't speak to a group of people!
[radio radio-427 use_label_element "Yes " "No"]
D. What am I doing? Am I where I need to be?
[radio radio-428 use_label_element "Yes " "No"]
E. In what areas of Your life, would you like to move into your greatness, now?
[textarea* textarea-30]
[recaptcha]

[submit "Submit"]

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Step 1 : Finding Your Centers

Step 2 : Locating Your Zones

Step 3 : Targeting Your Actions

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