Benchmarking Form (HYLN)

Benchmarking Form for Heal Your Life Now

Get ready for a beautiful life transformation. Fill out these questions as honestly and as thorough as possible. Celebrating your journey.

Full Name

Changed name or Nicknames you like to go by:

Best Email address

Phone Number

Mailing Address where you can receive goodies?

Birthday, place of birth & time of birth? We're going SOUL deep.

How fulfilled in life do you feel? On a scale of 1-10? 10 being amazingly fulfilled on every level of life (health, wealth, love, happiness)

Are you currently on any medication? If so, please list the name, when you started it and the purpose for the medication.

Have you previously had any surgery? Please list the date, the operation and the reason.

Do you have any allergies?

Does anything run in the family that you have fear around also getting from the famliy 'genes'?

Where do you experience regular tension or pain in your body?

Are you happy with your current weight? If not, how many pounds would you like to lose?

What do you think is the number one obstacle holding you back from success in your personal and professional life ?

What is your relationship status? (single, dating, married, divorced, widowed) and what would you love to experience in your future core relationship?

Are you a mother? Do you enjoy motherhood? If not, do you have a desire to be a mother or no?

What do you do for a career? On a scale of 1-10, how fulfilling is it? 1 meaning the job is Soul-sucking and you hate it, and 10 being you LOVE it and it LIGHTS you up!

Describe your relationship with money. Do you enjoy making, spending and investing money? Do you feel powerful & abundant or scarcity & stressed when thinking about and dealing with money?

Do you have a relationship with your mother, father or siblings? Which relationship is the strongest? Which is the weakest or the most triggering?

What bothers you the most in life? Think anytime you are triggered, frustrated or anxious...

If a genie were to grant you 3 wishes... what would they be?

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Benchmarking Form for Heal Your Life Now

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