Health Questionnaire | Menopause Wellbeing Retreats in Dorset and UK

Email Address *

First Name

Last Name

Phone Number

To what degree do you feel inspired by your work? *

Which statement applies to you regarding your creative potential *

I know my souls purpose *

I make a difference in the world *

Do you believe in anything other than this existence?*

I have a daily meditation practice (Meditation group/online/app/ meditative walk in nature) *

I struggle with self- criticism and perfectionism. *

I lack clarity and vision *

I enjoy learning new things *

To what degree do you experience anxiety? *

People describe me as an empath *

My moods are up and down *

I have a weekly self-care routine *

I feel honoured and adored by my partner *

I speak kindly and compassionately to myself *

I take recommended weekly exercise *

I have a healthy sex drive *

I have a healthy relationship with food *

At this time I embrace fully my current body image *

I believe and endorse "beauty comes from within" *

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