Thank you for taking the time to fill out this survey!
Please take a few minutes to answer the following questions as completely and honestly as possible. You will be emailed a copy of this survey after its completion.
Thank you for listening to Infants on Thrones. With your help, I can continue to transform this podcast into something creative, entertaining, and valuable.
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1.
What's your name?
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2.
What's your email?
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3.
Relationship Status
Married
Divorced
Other (Please specify)
Type here
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4.
What is your age?
18 to 25
26-35
36-45
46-55
56-65
66+
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5.
What are your greatest accomplishments? What are you most proud of in your life (go ahead and brag -- no one will hold it against you!)
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6.
What would you most like to change about yourself? List as many things as you can think of.
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7.
What are your greatest worries and concerns? List as many as you can think of.
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8.
Worldview Questions: These questions will help me see how you see yourself and the world around you. Please answer the following 20 questions by ranking each one as:
STRONGLY AGREE = I strongly believe this (75-100% probability) MOSTLY AGREE = I like thinking this way, but I am not completely sure (25-75% probability) AMBIVALENT = I'm not sure, I could go either way (0-25% probability) SLIGHTLY DISAGREE = I have significant doubts (25-75% improbability) STRONGLY DISAGREE = I don't believe this (75-100% improbability)
STRONGLY AGREE
MOSTLY AGREE
AMBIVALENT
SLIGHTLY DISAGREE
STRONGLY DISAGREE
Meditation is a healthy practice
Spirituality is a healthy way of looking at the world
Religion has an overall positive influence on the world
There is some kind of God or Supreme Intelligence in the Universe
Miracles happen on a daily basis
People who believe in miracles are setting themselves up for trouble
Thoughts create reality
I trust my instincts
I am a kind, loving, generous person
I am more than just my physical body
I am grateful for everything that happens in my life -- even the really hard stuff
The world would be a better place if people expressed more gratitude and less outrage
Everything pretty much boils down to two opposing forces: Love and Fear
I am solely in charge of my life
The thoughts that I think have ZERO impact on my reality
I have very deep feelings
I spend most of my time in my head
I am a very faithful person
It is hard for me to trust other people
It is hard for me to trust myself
The greatest miracle that could ever happen to me would be a change in my own perception
Everything I experience is only experienced in and through my own mind
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9.
How satisfied are you with the following aspects of your life?
Very Satisfied
Somewhat Satisfied
Indifferent
Slightly Unsatisfied
Very Unsatisfied
I'd Rather not Say
Career
Finances
General Relationships with Others
Sex Life
Spirituality
Physical Health and Appearance
Mental and Emotional Health
Hobbies
Self-confidence
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10.
YOUR CURRENT EMOTIONAL SPECTRUM: How frequently do you experience the following thoughts or emotions?
Very often
Often
Not sure
Not often
Never
Shame - I am humiliated and embarrassed about certain parts of who I am and things I have done
Guilt - I am to blame for things that go wrong - I often feel responsible for other people's mental and emotional pain
Apathy - I am so discouraged in certain areas of my life that I just don't care much about them any more
Grief - I have many regrets and it often weighs me down
Fear/Anxiety - I worry that I am going to lose important things in my life
Desire - I strongly want things that I currently do not have
Anger - It really annoys me that things aren't better than they are -- I hate it
Pride - A lot of my close family and friends are wrong about so many things -- it's annoying when they aren't aware of how wrong they are
Courage - It's hard to admit that there are things I don't know and that I could be wrong about things -- but I'm committed to learn the truth about myself, even if that means I'm wrong
Neutrality - I'm not going to take sides in an argument -- things can get complicated and I trust that everything will work itself out in the end
Willingness - I feel optimistic that whatever happens will turn out for the ultimate good, whether I really can understand that all or not
Acceptance - I forgive myself and others for mistakes we have made -- it's just an unavoidable part of life
Reason - It is possible to logically understand why things are the way they are
Love - I respect and admire myself and others most of the time
Joy - I respect and admire myself and others all of the time, unconditionally. Nothing can knock me out of this space of deep gratitude and appreciation for all aspects of life
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11.
SELF-ASSESSMENT: If you had to choose only ONE of the above emotions to describe the way you most commonly feel, which would you choose? (Pick one: shame, guilt, apathy, grief, fear, desire, anger, pride, courage, neutrality, willingness, acceptance, reason, love, joy). Please explain why.
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12.
YOUR EMOTIONAL GOALS: In the future, how frequently WOULD YOU LIKE to experience the following thoughts/emotions?
Very often
Often
Not sure
Not often
Never
Shame - I am humiliated and embarrassed about certain...
Guilt - I am to blame for things that go wrong - I often fee...
Apathy - I am so discouraged in certain areas of my life tha...
Grief - I have many regrets and it often weighs me down
Fear/Anxiety - I worry that I am going to lose important thi...
Desire - I strongly want things that I currently do not have
Anger - It really annoys me that things aren't better th...
Pride - A lot of my close family and friends are wrong about...
Courage - It's hard to admit that there are things I don...
Neutrality - I'm not going to take sides in an argument ...
Willingness - I feel optimistic that whatever happens will t...
Acceptance - I forgive myself and others for mistakes we hav...
Reason - It is possible to logically understand why things a...
Love - I respect and admire myself and others most of the ti...
Joy - I respect and admire myself and others all of the tim...
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13.
WHERE I WANT TO BE: If you could choose only ONE of the above emotions to describe the way that you would like to feel all of the time, which would you choose? (Pick one: shame, guilt, apathy, grief, fear, desire, anger, pride, courage, neutrality, willingness, acceptance, reason, love, joy). Please explain why.
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14.
Are you interested in finding out more about one-on-one coaching with me?
Yes, please email me the details of your one-on-one coaching packages.
Maybe, Maybe Not. I'll need to think about it.
No thank you. I just want to listen to the podcast.
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15.
Are you interested in finding out more about group coaching or weekend retreats with me?
Yes, please email me the details of your group coaching or weekend retreats.
Maybe, Maybe Not. I'll need to think about it.
No thank you. I just want to listen to the podcast.
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16.
Would you be willing to be coached "live" for a podcast episode?
Yes, I have benefitted from other people's public vulnerability and am willing to be publicly vulnerable myself.
Maybe, Maybe Not. I'll need to think about it.
No thank you. I just want to focus on me right now.
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17.
General Feedback: What do you think about the podcast in general? What kinds of topics would you like to hear discussed?