Questions will be tailored towards me working out your daily routines (when you wake, times you work, when you go to bed, have dinner, etc); based on your answers, I will be able to establish when is the best time for you to meditate, how long for, etc

This form will also help me distinguish what to include in your Daily Practice Plan (affirmations, journalling, gratitude, manifestation practices, etc).

If you have any questions or unsure, please contact me on WhatsApp!

Name *

First Name

Last Name

Email *

Phone

(###)

###

####

What do you need help with most during the Accountability Program?

Routine & Regularity in meditation practice

Help with alleviating stress

Help with alleviating anxiety

Deepening my practice

What is your biggest goal with the Accountability Program? What would you like to gain from this in 4-6 weeks time?

In your personal life, what are you goals for the next 3-6 months? Please include as much information as possible.

On a scale of 1-10; what are you current stress levels?

1 - super chill

5 - somewhere inbetween

10 - absolute meltdown, I'm a bomb exploding at everything

At present, what are you struggling with most in your meditation practice?

If you've been out of practice, how long for roughly? (please be honest)

When you were meditating, how did you practice look? (eg. once every 3 days for 10 mins)

What would you say is your biggest challenge towards meditating? (works, social life, family life, etc)

Is there anything that could be hindering your meditation practice? (drinking, smoking, partying)

What is your sleep quality like?

If you struggle with sleep quality - do you struggle to fall asleep or do you wake during the night and struggle to fall back asleep?

On average, how many hours of sleep do you get a night?

1 - 5 hours

5 - 7 hours

7 - 9 hours

9 + hours

Below are daily boxes; in these boxes I would like you to include as much information possible about your daily routine. Please include - when you would normally wake, when you work, have dinner, go to bed, and anything unique you do on that day (gym, football practice, piano class, etc). If you meditate on some of these days, please include what time you would usually meditate and for how long. The more information the better!

Monday: *

Tuesday: *

Wednesday: *

Thursday: *

Friday: *

Saturday: *

Sunday: *

Any other weekly commitments that will be helpful to know? Eg. having your kids every second week, new job starting in the next few weeks, etc

Below is some questions to gauge when you will be able to take your sessions for the Accountability Program & how you would like to pay.

Sessions are £40-50 per session, would you prefer to pay for all 4 in a block or per session? *

When are you able to take your sessions? During the day or evenings?

What days suit you best to take your sessions?