Name *

First Name

Last Name

Are you bored with your life?

Yes

Sometimes

No

Is there anything to look forward to?

Yes

Sometimes

No

Are you relying on habit vs. inspiration to get things done?

Yes

Sometimes

No

Have you forgotten why you signed up for this in the first place?

Yes

Sometimes

No

Do you notice your moment-to-moment experience?

Yes

Sometimes

No

Are you grumpy and grouchy?

Yes

Sometimes

No

Do people walk on eggshells around you?

Yes

Sometimes

No

Are you making excuses for your lousy mood? (Mid-life crisis, bad management, lousy partner, worthless team, idiotic drivers, hormones, etc)

Yes

Sometimes

No

Have you given up on fulfilling your goals?

Yes

Sometimes

No

Have you given up on fun and happiness? ("It's for lazy losers who are weak and pathetic")

Yes

Sometimes

No

Are you reactive vs. proactive?

Yes

Sometimes

No

Have you lost sight of your long-term goals and objectives?

Yes

Sometimes

No

Do you have low energy, which affects your ability to put energy into taking powerful actions?

Yes

Sometimes

No

Do you have the blues?

Yes

Sometimes

No

Are you depressed when you think about tomorrow?

Yes

Sometimes

No

Do you dread parts of your life?

Yes

Sometimes

No

Have you given up on enjoying the day?

Yes

Sometimes

No

Are you just in it for the money?

Yes

Sometimes

No

Do you spend time fantasizing about a future that never comes?

Yes

Sometimes

No

Do you spend time envying others?

Yes

Sometimes

No

Do you compare yourself to others and always come up short?

Yes

Sometimes

No

Do you focus on the shortcomings of others without communication or resolution?

Yes

Sometimes

No

Are you bored or irritated with answering these questions? :-)

Yes

Sometimes

No

Do you feel entitled or unappreciated personally and/or professionally?

Yes

Sometimes

No

Underneath it all, are you insecure about your ability to be productive and create results?

Yes

Sometimes

No

Do you find yourself dwelling in judgement, assessment, cynicism, and bitterness?

Yes

Sometimes

No

Have you given up caring about what others think of you?

Yes

Sometimes

No

Do you shut people down or cut people off when they talk with you?

Yes

Sometimes

No

Do you have a lack of respect for most people?

Yes

Sometimes

No

Are you in a continuing downward spiral?

Yes

Sometimes

No

Is your energy low most of the time?

Yes

Sometimes

No

Are you tired shortly after you wake up?

Yes

Sometimes

No

Do you feel like taking a nap often?

Yes

Sometimes

No

Do you look forward ot your breaks, days off, and vacations more than work?

Yes

Sometimes

No

Are you hyper focused on easy ways out of your current reality? (A drink, TV, video games, food, etc)

Yes

Sometimes

No

Do the smallest details overwhelm you?

Yes

Sometimes

No

Do you feel like 'one more thing' is going to cause you to explode or cause you to crumble?

Yes

Sometimes

No

Do you avoid things in life to avoid overwhelm?

Yes

Sometimes

No

Are the things that used to make you happy no longer interesting?

Yes

Sometimes

No

Are you looking for ways to check out?

Yes

Sometimes

No

Have you lost your ability to see beauty in people, nature, art, etc?

Yes

Sometimes

No

Are you inspired by music, poetry, or a kiss?

Yes

Sometimes

No

Do you seem to never have enough time?

Yes

Sometimes

No

Are your goals unattainable?

Yes

Sometimes

No

Do you experience low productivity?

Yes

Sometimes

No

Have you given up on motivation and confidence as a source of energy and drive?

Yes

Sometimes

No

Are you uninspired and uncaring?

Yes

Sometimes

No

Does other people's attempts to 'support' you create irritation?

Yes

Sometimes

No

Do you compartmentalize your life so no one knows the whole story?

Yes

Sometimes

No

Are you cut off from or ignoring some important part of your self or your life?

Yes

Sometimes

No