28 Day Detox Questionnaire Package 2

You will never change your life until you change something you do daily.
The secret of your success is found in your daily routine.

28 Day Detox Questionnaire - Package 2

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Think about your energy levels, stress levels, weight, mood, head-space, work-life etc. and answer the following questions.
Be honest and thorough with your thoughts.

How do you feel today? *

How do you want to feel? *

What are your intentions when considering the Detox for April? *

What kind of support are you looking for during April? *

Goals/Practices

I’d like for you to think about your goals in two parts.
PRIMARY goals - These goals will be challenging, achievable & realistic and above all – IMPORTANT. These are the reasons that you have decided to commit to the 28 day detox. These will include the building of healthy habits and detox practices. Include as many as you like but PLEASE, don’t set yourself up for failure. Be kind and think about what is most important right at this moment.

SECONDARY goals - You may also want to add smaller goals that you feel will support you in your quest to experience the benefits that detoxing offers such as increased energy, better sleep, better mood, clearer skin & a clearer mind. This could include incorporating mindfulness practices or making your own skin or cleaning products.

Define one or two PRIMARY goals or practices you would like to focus on in April *

Define any SECONDARY goals (optional). *

Goals/Practice

Think about the goals/practices you want to focus on during the 28 day detox in April.

Goal/Practice 1 *

What is your current relationship with the goal or practice that you are working towards? *

Why is reaching your goal or pursuing this practice important to you? *

How important is it to reach your goal or pursue this practice? (1 being not very important, 5 being VERY important) *

How will you feel if you are successful in reaching your goal or pursuing a practice? *

Give some thought to the barriers you may encounter that may stop you from following through with your intentions. How will you approach and overcome these? *

Is there anyone you can rely on to support you through the month of April? *

What will motivate you to follow through on your commitment to this change? *

Goal/Practice 2 *

What is your current relationship with the goal or practice that you are working towards? *

Why is reaching your goal or pursuing a practice in this area important to you? *

How important is it to reach your goal (1 being not very important, 5 being VERY important) *

How will you feel if you are successful in reaching your goal or pursue a practice? *

Give some thought to the barriers you may encounter that may stop you from following through with your intentions. How will you approach and overcome these? *

Is there anyone you can rely on to support you through the month of April? *

What will motivate you to follow through on your commitment to this change? *

Is there anyone you can rely on to support you through times when you’re feeling unmotivated? *

Let's do it!

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