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What grounds you? What gives you emotional or mental stability? What helps you feel a sense of balance?
 
My partner
 
My child(ren)
 
My spirituality
 
Exercise or spiritual practice (yoga, bicycling, hiking, meditation, etc.)
 
Nature
 
Other (people, places, activities, things)
 

 
 
 
What do you feel consumes too much of your energy?
 
My partner
 
My child(ren)
 
Television/Internet
 
Work
 
Community
 
Church
 
Other
 

 
 
 
What worries you often?
 
Money
 
My relationship
 
Work
 
My health
 
Other
 

 
 
 
What do think are your vices?
 
Smoking
 
Drinking
 
Television/Internet
 
Drugs
 
Food
 
Other
 

 
 
 
With who or where do you feel it is appropriate to discuss sex and sexuality?
 
With my partner
 
With my child(ren)
 
Sex education in school
 
With a spiritual counselor or minister
 
In the media
 
Other
 

 
 
 
Overall, in regards to relationships (romantic, work-related, parental, platonic) are you...
 
more of a giver
 
more of a receiver
 
an equal balance between giver and receiver
 
 
 
What guides you on your spiritual path?
 
I don't believe I have a spiritual path
 
The way I was raised
 
My curiousity and yearning to learn more
 
My past experiences
 
Other
 

 
 
 
What is vulnerabiltiy to you?
 
Loss
 
Love
 
Showing my True Self to others
 
Baring my Soul to those close to me
 
Other
 

 
 
 
Do you believe you know your authentic self (do you know your soul)?
 
Yes
 
No
 
Unsure
 
 
 
Do you feel the authentic Self, the True You, continually changes?
 
Yes
 
No
 
Unsure
 
We are ALL a part of each other.
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