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RTHB Questionnaire

Name *

First

Last

Email *

Your Experience *

Rate 1 out of 5Rate 2 out of 5Rate 3 out of 5Rate 4 out of 5Rate 5 out of 5

Overall, how would you rate your experience with us?

I notice and am aware of how I feel *

Never
Seldom
Sometimes
Often
Always

I feel what I want and what matters to me *

Never
Seldom
Sometimes
Often
Always

I feel what I do not want *

Never
Seldom
Sometimes
Often
Always

My choices are based upon my wants and what matters to me *

Never
Seldom
Sometimes
Often
Always

My choices are based upon my not wants *

Never
Seldom
Sometimes
Often
Always

I express my choices truly and freely *

Never
Seldom
Sometimes
Often
Always

I practice self-care for heart, mind, body, spirit *

Never
Seldom
Sometimes
Often
Always

l have discovered and my passions are part of my life *

Never
Seldom
Sometimes
Often
Always

l put my energy into my wants, passions and what matters to me *

Never
Seldom
Sometimes
Often
Always

I realise my purpose and live it. *

Never
Seldom
Sometimes
Often
Always

I let go of the past including grudges, hurts, mistakes etc *

Never
Seldom
Sometimes
Often
Always

I feel that I related to others from the heart *

Never
Seldom
Sometimes
Often
Always

I notice my feelings and truly express them *

Never
Seldom
Sometimes
Often
Always

I feel free *

Never
Seldom
Sometimes
Often
Always

I feel happy when I am by myself *

Never
Seldom
Sometimes
Often
Always

I am open to what life brings *

Never
Seldom
Sometimes
Often
Always

I feel safe to bring all that I have *

Never
Seldom
Sometimes
Often
Always

I practice being still and at peace *

Never
Seldom
Sometimes
Often
Always

I feel that I can be truly all of who I am *

Never
Seldom
Sometimes
Often
Always

I feel that I am living life fully *

Never
Seldom
Sometimes
Often
Always

I feel fulfilled/contented with my relationships and life *

Never
Seldom
Sometimes
Often
Always

I feel happiness from my heart *

Never
Seldom
Sometimes
Often
Always

I get out into nature *

Never
Seldom
Sometimes
Often
Always

I do things because I feel I should, out of duty or to please others *

Never
Seldom
Sometimes
Often
Always

I feel that I do not have enough time *

Never
Seldom
Sometimes
Often
Always

I feel my busy mind *

Never
Seldom
Sometimes
Often
Always

I feel that time goes by in a blur *

Never
Seldom
Sometimes
Often
Always

I feel anxious or stressed *

Never
Seldom
Sometimes
Often
Always

Additional comments or suggestions

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