Date:

Time (optional):

These are the factors that you'll probably want to be high for maximum effectiveness.

Please rank your average level since your last report (10 being the highest):

Physical Energy

1  2  3  4  5  6  7  8  9  10

Mental Energy

1  2  3  4  5  6  7  8  9  10

Emotional Energy

1  2  3  4  5  6  7  8  9  10

Spiritual Energy

1  2  3  4  5  6  7  8  9  10

Positive Focus

1  2  3  4  5  6  7  8  9  10

Presence (being in the moment)

1  2  3  4  5  6  7  8  9  10

Happiness

1  2  3  4  5  6  7  8  9  10

Expression (acting, being, emoting, speaking as the "real" me)

1  2  3  4  5  6  7  8  9  10

Flow (experience of "being in the flow of things")

1  2  3  4  5  6  7  8  9  10

Saying "YES" to each moment (accepting and even loving what is)

1  2  3  4  5  6  7  8  9  10

~~~

These are the factors that you'll probably want to be low for maximum effectiveness.

Please rank your average level since your last report (1 being the lowest):

Stress

1  2  3  4  5  6  7  8  9  10

Worries

1  2  3  4  5  6  7  8  9  10

Procrastination

1  2  3  4  5  6  7  8  9  10

Judgments (labeling of self, others, things, events)

1  2  3  4  5  6  7  8  9  10

Fears

1  2  3  4  5  6  7  8  9  10

Comments:

Your email address:

Confirm your email address: