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Pre assessment Form
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Pre assessment Form
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Name:
*
Age:
*
Nationality:
*
Subject:
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Rate the following aspects :
How calm and peaceful is my mind in daily life?
choose one:
*
Excellent
Good
Average
Bad
Very Bad
How well can I stay focused and present in the moment?
choose one:
*
Excellent
Good
Average
Bad
Very Bad
How aware am I of my breathing, and how well can I control it?
choose one:
*
Excellent
Good
Average
Bad
Very Bad
How capable am I of managing my emotions in challenging situations?
choose one:
*
Excellent
Good
Average
Bad
Very Bad
How would I describe my level of life energy vitality throughout the day?
choose one:
*
Excellent
Good
Average
Bad
Very Bad
How deeply do I perceive the connection between my mind, body, and emotions?
choose one:
*
Excellent
Good
Average
Bad
Very Bad
How confident do I feel when making personal or professional decisions?
choose one:
*
Excellent
Good
Average
Bad
Very Bad
How calm and centered do I remain under stress?
choose one:
*
Excellent
Good
Average
Bad
Very Bad
How strong is my sense of purpose and satisfaction with life?
choose one:
*
Excellent
Good
Average
Bad
Very Bad
How balanced do I feel between logic and emotion within myself?
choose one:
*
Excellent
Good
Average
Bad
Very Bad
Previous experience with meditation, breathing practices, or coaching (Yes/No – if yes, please describe briefly):
choose one:
*
Always
Often
Sometimes
Rarely
Never
What is your personal goal or intention for participating in this program?
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