Personal Program Questionnaire

Full name as it stands at this point in your life please. It is your energy, and it all counts.

Important to be accurate - this is your signature of entry into this life.

Please take a photo now, or include as recent a photo as you can.

Remember. everything you write here is confidential and is not shared with anyone except Jason.

Be direct, honest and open.

As emotive as you can, not analytical. Don't be the observer!

Objective goals or a state of mind - whatever matters most to you.

Any time, place or memory. No limits!

Don't hold back. This is about you. Don't think about anyone else at all or how they would feel about it - just You.

Don't think too hard. Let your emotional connection, or a burst of memory, guide you. Sometimes what we think and what we feel can be very different.

Again, an actual thing, event or feeling. What matters most is that it is something possible to change. If it cannot be changed, then your response to it can.

How you see you, not how others see you.

Select multiple choices by holding the CTRL key down (or 'control' key on a mac) and click on all the ones that apply.

This does not have to be the same email address as your Quiet Place account.