Exploring --- Empowering — Enlightening, Since 1986 ™
Your "Virtual Introduction" is a considerate starting point. Do it firstly Yourself, secondly to consider areas you may find yourself ready to explore in depth. Thirdly, you may find it useful for discussion with your Personal Coach later. This one foundation post, an overview, a starting place, the deeper issues naturally come with time, work, trust and courage.
A key component of your personal power, is total honesty with Yourself. Any form of denial or blame only prolongs your karmic record. You want to do this by putting yourself in a calm, peaceful way as you ask yourself: what do I feel as I experience this personal review ? Am I being totally honest with myself, why am I doing this at this time in my life? Where do I hope this will take Me?
Do Not think about each Question in great detail, you should be able to respond “from the heart” adding detail as it comes to you in review and further analysis. This tool is a personal power building exploration.
The Quest Part One ~ Family -- Early Childhood – Extended Family
My Early Childhood was
Excellent Yes No [ place X next to correct feeling/answer ]
Good Yes No
Bad Yes No
[ Add personal reflections here ]
Indifferent Yes
No
[ I feel.... ]
From the world of Hell Yes No
[ if you wish to add more, use separate page, your comments and thoughts will empower You ]
Parents
Excellent Yes
No
Good Yes
No
[
add personal reflections here ]
Bad Yes
No
Indifferent
Yes No
[
I was closer to... mom / dad, equal, neither ] From the world of Hell Yes
No
Extended Family....
The Three People Who Have Influenced Me Most Are / Were:
1 ] Name / Relationship / Influence Ie: Friend, Foster Parent, Aunt, Ie: Positive/Negative
influence
Time Frame / How long were they in your life ? ______________ years
How did they influence You ?
2 ] Name Relationship Influence
Time Frame / How long were they in your life ? ______________ years
How did they influence You ?
3 ] Name Relationship Influence
Time Frame / How long were they in your life ? ______________ years
How did they influence You ?
The Three Most Important Events That Have Shaped My Life Are / Were:
1 ]
2 ]
3 ]
The Three Places I Love the Most are; They are Important to Me because......
1 ]
Because:
2 ]
Because:
3 ]
Because:
If I could live anywhere it would be: _________________________________
EMPOWERING MySelf Part 2 My ENVIRONMENT
My Physical and Mental Living [ Space ] EnvironmentLiving Environment is / was
IS x Was x
Excellent Excellent
Good Good
OKay OKay
[ Add personal reflections here: ie: big city, small town, fancy home, lots of space, no space
Bad Bad
From the world of Hell
My Financial Environment:
IS Was
Wealthy Wealthy
Middle Class Middle Class
A Struggle A Struggle
Very Poor Very
Poor
I Am: Very Good Mmediocre Bad with money and investments
The Quest: Part 3 ] HEALTH
Generally my Physical Health has been ? Excellent ? Good ? Fair ? Sickly
I see a sickness Doctor: Seldom Once
a Year Only when necessary
I believe in: Do Not believe in: Naturopathic Doctors
& / or Holistic HealthCare
Other kinds of Medical Care I receive :
My Eating Habits include: Vegetarian I
like Food, Food likes me [East most everything]
No
Dietary Problems Need to work on Diet
& Exercise
When it comes to Food, I Feel:
I do Drugs [ prescription only ] Everyday As Needed Seldom
I have suffer / have suffered from the following major disease/s: [ name them / list them ]
When it comes to alcohol, I would say: I don’t have a problem I Do I am in denial
In my Family addictions plays /played a Major Minor Non
role in my Being
role.
There ? Was ? Was Not a problem with alcohol in my family in my growing
years. The problem was with ? Mother ? Father ? Other
Over the past five years Mentally on a Scale of 1 - 10 [ ten being High ] I would Rate Myself: Circle One 1 2 3 4 5 6 7 8 9 10
The Quest: Part 4 RELATIONSHIPS
My Personality: I Feel I Am: A comfort seeker, a status seeker, a defender, an idealist, a realist, a maverick, an entertainer, a protector. I see myself as an extra-vert introvert, or ambivert? How do you think others see You?
When it comes to Loving others, I find it: Easy So-So Difficult I don’t understand the Question
I Feel I AM Loved: Greatly Somewhat Not nearly enough
When it comes to Partners / Marriage / Significant Others:
I have been Married [ X_______ ] ie: 3 times ]
I have a Soul Mate Am Searching For Would
like to know what a Soul Mate is?
I have a problem with the following extended Family Member(s):
[ First name of person/s, relationship in Your life ]
When It Comes to Relationships, I
Feel:
The Quest: Part 5 ] My SPIRITUAL Feelings
When it comes to faith: I Doubt It I Question It I have actual proof
When it comes to religion: I have difficulty It turns me off I have a Religion I practice
I practice my Religion because: I was taught to I believe
in Guardians/Messengers/Teachers
I have explored some spiritual pathways but haven’t found the one that is right for me yet
When it come to Faith, Religion and Spiritual Experience, I Feel:
Henry, I would like to ADD the following important Information to assist my Personal Coach!
[ See over/separate sheets for more......... ]
My Name:
e-Mail Address:
CHAT Address:
Notes / Writings / Information
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Thanks in great part to the Internet, we are moving towards a much more open
and sharing world.
Please feel free to pass along this Quest-ionaire to anyone You Feel would benefit
by it. Henry.
Phone: 250. 715. 1976 Questionnaire
Response! Return to PenLan Buddha
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