Welcome to Rebalance
Before We Begin,
Tell Us Where
You Are.
This short intake helps us understand where you are right now — so we can support your 8-week journey with full intention. There are no right or wrong answers. Just your truth.
Relationships
Relationship
with Self
with Self
On a scale of 1–10, how would you rate your current relationship with yourself, including self-love, self-trust, and inner dialogue?
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10
StrugglingThriving
Relationships
Relationship
with Others
with Others
On a scale of 1–10, how fulfilled do you feel in your relationships with others, including friends, family, and community?
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IsolatedDeeply Connected
Relationships
Romantic
Relationships
Relationships
On a scale of 1–10, how satisfied and aligned do you feel in your romantic relationships or your ability to create the romantic relationship you desire?
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UnfulfilledDeeply Aligned
Wellness
Physical
Health
Health
On a scale of 1–10, how would you rate your current physical health, energy levels, and overall vitality?
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DepletedVital & Energised
Wellness
Mental &
Emotional Health
Emotional Health
On a scale of 1–10, how would you rate your mental and emotional well-being, including your ability to manage stress, thoughts, and emotions?
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OverwhelmedClear & Resilient
Wellness
Spiritual
Connection
Connection
On a scale of 1–10, how connected do you feel to your spirituality, purpose, or sense of inner alignment?
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DisconnectedDeeply Aligned
Financial
Where Are You
With Money?
With Money?
When it comes to money, which of the following best describes where you are right now?
A
Money flows well — but I still feel like something is missing (purpose, connection, or relationships).
B
I'm financially comfortable but emotionally or spiritually unfulfilled.
C
Money is a constant stress — it feels like the main thing blocking my life.
D
I have everything I need on the outside, yet I often feel empty or disconnected on the inside.
Financial
Your Relationship
to Income
to Income
How would you describe your relationship to building and creating income?
A
I'm an entrepreneur — I have a business that generates consistent revenue.
B
I'm building something, but income is inconsistent and I'm still figuring it out.
C
I work for someone else — but I have a vision to create something of my own.
D
I'm not sure I identify as an entrepreneur — I'm still exploring what I'm meant to do.
Financial
Income
Earned
Earned
How much have you earned in a single year — through business, a windfall, salary, or any source?
A
Under $80,000
B
$80,000 – $200,000
C
$200,000 – $500,000
D
Above $500,000
✓
You're
In.
In.
Your responses have been received. Welcome to Rebalance — your 8-week journey begins now. Check your inbox for what comes next.