How supported and safe do you feel in your relationships with family, friends, or coworkers?
*
I feel fully supported and surrounded by uplifting people
I feel mostly supported, with a few draining relationships
I often feel judged, misunderstood, or alone
I feel completely overwhelmed by the people in my life
How often do you feel calm and emotionally balanced throughout your day?
*
Almost always—I can process my emotions with ease
Often—but big emotions sometimes throw me off
Rarely—I feel reactive, overwhelmed, or disconnected
Almost never—I'm emotionally exhausted or numb
How does your home or physical environment make you feel?
It’s peaceful, organized, and reflects who I am
It's somewhat calming, though clutter or mess creeps in
It feels chaotic, and I avoid certain areas because they stress me out
It drains me—I feel trapped, stressed, or overstimulated by my surroundings
How manageable does your day-to-day life feel right now?
*
I have a good rhythm and feel in control of my schedule
I juggle a lot but manage most days okay
I’m constantly putting out fires and feel behind
I’m drowning—my to-do list rules my life
How well are you caring for your body, mind, and spirit?
*
I prioritize myself and feel nourished in all areas
I do okay, but I wish I had more time or energy
I put myself last and often feel depleted
I can’t remember the last time I truly took care of me
First Name
*
Last Name
Email
*