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Whitney
Section 1: Reflection
First name
Email
When you started this program, what were you hoping would change?
Long What changed most over the last 30 days?
What surprised you about yourself during this process?
Which lesson or prompt had the biggest impact on you?
What resistance showed up most often?
Avoidance
Perfectionism
Fear
Distraction
Self-doubt
People pleasing
Lack of consistency
Nothing that you noticed
Other
Section 2: Self-Trust Score
Rate 1-10. 1 being least, 10 being most.
How connected do you feel to yourself today?
How much do you trust yourself today?
How clear are you on what matters most to you?
How confident are you in making decisions aligned with your values?
How capable do you feel handling difficult emotions without escaping them?
Section 3: Behavior Change
What specific behaviors have changed?
Better boundaries
More honest communication
Less people pleasing
More self-care
More intentional decisions
Better emotional awareness
Less avoidance
Improved relationships
Greater confidence
Other
What commitment are you taking forward from this experience?
What still feels unresolved?
Section 4: Qualification
Do you feel you need additional support to continue this work?
Yes
No
Maybe
If yes, what type of support feels most helpful right now?
Self-paced resources
Community
Group coaching
One-on-one coaching
Retreat
Not sure
Other
What is your biggest challenge right now?
(1-10) How committed are you to continuing this work over the next 6 months?
Would you be interested in learning about future coaching opportunities?
Yes
No
Maybe
What would you tell someone considering this program?
May I use your feedback publicly?
Yes, with my name
Yes, anonymously
No
Submit
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