Personal Development - Peak States of Consciousness - Inner Unity - Coaching
mail@danielzeiss.com
+49-157-92369213
Home
Be The Change
Peak States of Consciousness
Inner Unity
About
Menu
Home
Be The Change
Peak States of Consciousness
Inner Unity
About
Silent Mind Process Questionnaire
Step
1
of
5
20%
Personal Information
Name
*
First
Last
Date of birth
*
DD slash MM slash YYYY
Email
*
Newsletter Opt-in
I would like to sign up for email updates (newsletter) and receive them from Daniel Zeiss. See privacy policy.
Thank you Advance Consciousness for creating this questionnaire!
Questions
Please answer the questions below as truthfully as possible. Please don't think TOO MUCH about the answer, just answer it rapidly. Thinking might influence the correctness. In some of the questions, you will be asked to give a rating between 0 to 10, with 0 being equal to not at all, and 10 the maximum you can imagine.
How stuck do you feel in your life in general?
*
Please select an answer
0 (not at all, no problem for me)
1
2
3
4
5
6
7
8
9
10 (very much, big problem for me)
Do you feel like friends and family are holding you back, e.g. with their opinions of your plans?
*
Please select an answer
0 (not at all, no problem for me)
1
2
3
4
5
6
7
8
9
10 (very much, big problem for me)
How would you rate the amount of "noise" in your head (mindchatter)? Background humming - poking - distinguishable voices (e.g. inner critic) - involuntary channeling?
*
Please select an answer
0 (none)
1
2
3
4
5
6
7
8
9
10 (a lot)
Do you have addictive patterns? This is not just about drugs and alcohol, could be chocolate, sex, shopping, gambling etc.
*
Please select an answer
0 (none)
1
2
3
4
5
6
7
8
9
10 (many)
How easy do you find it to meditate without getting distracted?
*
Please select an answer
0 (very easy)
1
2
3
4
5
6
7
8
9
10 (very difficult)
Do you feel heavy, like you have a burden on your shoulders, independent of your actually weight?
*
Please select an answer
0 (no, not at all; feeling light)
1
2
3
4
5
6
7
8
9
10 (yes, feeling very heavy)
If you could look through your belly button like a window - how dark do you perceive the space outside this window? (When you think of resolving your most pressing issue?)
*
Please select an answer
0 (appears light)
1
2
3
4
5
6
7
8
9
10 (appears really dark)
How strong do you think in terms of "we" and "them" (Football clubs, foreigners, political parties, etc)?
*
Please select an answer
0 (not at all)
1
2
3
4
5
6
7
8
9
10 (very often)
Projects
This section is about your projects and goals. Please first specify the projects in a few words and then give your answers below to the questions.
Project / Goal 1 of 3
*
Please enter a personal goal or project. Something that is important to you.
Project / Goal 2 of 3
*
Please enter a second personal goal or project. Something that is important to you.
Project / Goal 3 of 3
*
Please enter a third personal goal or project. Something that is important to you.
How do you experience your progress for goal / in project 1 (see above)?
*
Please select an answer
0 (fast, not a problem)
1
2
3
4
5
6
7
8
9
10 (slow, big problem for me)
How do you experience your progress for goal / in project 2 (see above)?
*
Please select an answer
0 (fast, not a problem)
1
2
3
4
5
6
7
8
9
10 (slow, big problem for me)
How do you experience your progress for goal / in project 3 (see above)?
*
Please select an answer
0 (fast, not a problem)
1
2
3
4
5
6
7
8
9
10 (slow, big problem for me)
Relationships
Person 1 of 3
*
Please specify the name of the first person close to you. For example, your parents, siblings, partners, friends, work colleagues, or others.
Person 2 of 3
*
Please specify the name of the second person close to you. For example, your parents, siblings, partners, friends, work colleagues, or others.
Person 3 of 3
*
Please specify the name of the third person close to you. For example, your parents, siblings, partners, friends, work colleagues, or others.
How do you experience your relationships with Person 1? Is it mostly about the same underlying emotional messages?
*
Please select an answer
0 (not a problem, same emotional message)
1
2
3
4
5
6
7
8
9
10 (big problem for me, many different underlying emotional messages)
How do you experience your relationships with Person 2? Is it mostly about the same underlying emotional messages?
*
Please select an answer
0 (not a problem, same emotional message)
1
2
3
4
5
6
7
8
9
10 (big problem for me, many different underlying emotional messages)
How do you experience your relationships with Person 3? Is it mostly about the same underlying emotional messages?
*
Please select an answer
0 (not a problem, same emotional message)
1
2
3
4
5
6
7
8
9
10 (big problem for me, many different underlying emotional messages)
How "complicated" are your interactions with people in general?
*
Please select an answer
0 (not complicated)
1
2
3
4
5
6
7
8
9
10 (very complicated)
How vulnerable do you feel to other peoples verbal or unspoken attacks?
*
Please select an answer
0 (not vulnerable)
1
2
3
4
5
6
7
8
9
10 (very vulnerable)
Do you have co-dependent patterns? Do you find yourself secretly sabotaging others when they are trying to improve? e.g. bringing home chocolates when your partner is trying to lose weight.
*
Please select an answer
0 (none)
1
2
3
4
5
6
7
8
9
10 (very many)
Do you experience physical pains (pricks, jabbing) or blanking out during or immediately after interactions with others?
*
Please select an answer
0 (no, not at all)
1
2
3
4
5
6
7
8
9
10 (yes, very often)
Birth country, Expatriate ....
How "alien" do you feel where you live? i.e Not belonging?
*
Please select an answer
0 (no, not at all)
1
2
3
4
5
6
7
8
9
10 (yes, very much)
Are you living in a culture that is not the one you were born into?
*
Please select yes or no
Yes
No
Hidden
Points
Results...
Should the results be sent by e-mail?
*
Yes, I would like to receive my result by e-mail and have it displayed.
No, I don't want to receive my result by email and just have it displayed here.
Approval results by e-mail
*
I am aware that e-mail may transmit data partially unencrypted. I would like to have my personal data delivered by e-mail.
No, please do not send me the results by e-mail. It is enough for me to look at them here.
Consent
*
I agree to the data processing.
*
I hereby confirm that I have read and agree to the Privacy Policy.
CAPTCHA
