Personal Empowerment Assessment Your Details Name Email Phone Self-Assessment Questionnaire 1. Do you have existing pain points? YesNoNot Sure Short Note (optional) 2. Do you feel stagnated in mind, body, and spirit? Strongly DisagreeDisagreeAgreeStrongly Agree Short Note (optional) 3. Would you like to activate your true identity? Strongly DisagreeDisagreeAgreeStrongly Agree Short Note (optional) 4. Are you presently employed in an occupation you have passion for? YesNo Short Note (optional) 5. Do you live the P3 Theory of Passion / Purpose / Possibility Lifestyle? YesNoNot Sure Short Note (optional) 6. Do you feel you’re living in balance? YesNoNot Sure Short Note (optional) 7. Are you living in imbalance with organized chaos? Strongly DisagreeDisagreeAgreeStrongly Agree Short Note (optional) 8. Are you existing in a safe place — your comfort zone? Strongly DisagreeDisagreeAgreeStrongly Agree Short Note (optional) 9. Are you living with poor time management habits? YesNoNot Sure Short Note (optional) 10. Are toxic people and toxic environments sabotaging you? YesNoNot Sure Short Note (optional) Closing Reflection What specific action will you take this week to begin activating balance in your life? Final Question Would you like assistance or a coach? YesNoNot sure
