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A Self-Inquiry Questionnaire

This questionnaire is designed to help you slow down, listen inward, and notice what is quietly shaping your stress, choices, and sense of ease. There are no right or wrong answers. Write what’s true for you — even if it feels unfinished.

Part 1: What’s Here Right Now

  1. Right now, the area of my life that feels most stressful or charged is:
  2. When I think about this situation, the strongest emotion I notice is: ( ) Anxiety ( ) Sadness / grief ( ) Anger / resentment ( ) Fear ( ) Numbness ( ) Other: ____________
  3. In my body, this stress shows up most as:

Part 2: The Thought That Causes Stress

  1. If I had to put my stress into one simple sentence, it would be:
  2. I most often believe this thought when: ( ) I’m alone ( ) I’m with family ( ) I’m at work / school ( ) I’m tired or overwhelmed ( ) Other: ____________
  3. On a scale of 0–10, how true does this thought feel right now? 0 1 2 3 4 5 6 7 8 9 10

Part 3: Impact

  1. When I believe this thought, I notice that I: ( ) Pull away or shut down ( ) Over-explain or defend ( ) Try to fix or control ( ) Numb out ( ) Get hard on myself
  2. When I believe this thought, my relationships tend to feel:
  3. When I believe this thought, my body tends to:

Part 4: Support and Readiness

  1. When it comes to emotional support, I tend to: ( ) Handle things on my own ( ) Talk, but keep my guard up ( ) Reach out easily ( ) Avoid asking for help
  2. Right now, what I most want is: ( ) Relief ( ) Clarity ( ) Emotional safety ( ) Deeper self-trust ( ) Better relationships ( ) Other: ____________
  3. On a scale of 0–10, how open do I feel to self-inquiry and support? 0 1 2 3 4 5 6 7 8 9 10

Closing Reflection

  1. One thing I see more clearly after answering these questions is:

If you are drawn to discovery and guidance delivered with simplicity, curiosity, and caring support book a free 30-minute consult or half off your first 90-minute coaching session when you email this questionnaire to:

                               coachingheartofthematter@gmail.com

Go to heartofthemattercoaching.us and click ‘contact me’.

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You may also text me at 415-595-2739 and mention this questionnaire.