Kumaya World Assessment Form

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What feels most uncertain or unstable in your life right now?

My health habits feel inconsistent My energy is unreliable My mind feels scattered or overloaded My emotions feel heavy or hard to regulate I feel disconnected from myself and what matters Several areas feel unstable at once

How is that showing up in your day-to-day life?

I'm tired even when I rest My habits fall apart when life gets stressful I overthink and struggle to focus I feel emotionally stretched thin I keep functioning, but I don't feel like myself I know something needs to change, but I haven't found a system that sticks

Which area needs the most support right now?

Select all that apply.

Mind Body Emotions Sense of direction / purpose

What would make the biggest difference in your life over the next 90 days?

More stable energy Better emotional control More mental clarity and focus Better routines and follow-through Feeling grounded in who I am again A health system I can actually sustain

What kind of support are you looking for right now?

Help understanding the deeper root of what's keeping me stuck Help getting mentally and emotionally clear again A clear structure I can follow and stay consistent with Support holding healthy habits even when life gets hard Help making change feel natural, stable, and fully part of me I need support across more than one area

What best describes your timing right now?

I'm ready to make changes now I know I need support soon, but I'm not fully ready I need more clarity before I commit I'm exploring, but this isn't a priority yet I want change, but my current life situation makes it hard to act

Finally, a few statements to help us understand your starting point.

How You Respond

These narrow it down to where you actually are.

When life gets hard, my routines usually fall apart.

My energy has been less stable than I want it to be.

I feel mentally overloaded more often than clear.

I can usually notice my emotions before they take over.

Even when I know what to do, I struggle to stay consistent.

I feel connected to what matters most to me right now.

I rely more on motivation than on systems.

Stress affects my eating, sleep, or health habits.

One Last Step

A few questions to confirm the right starting point for you.

On a scale of 1–10, how open are you to daily devotion and self-accountability practices?

Not at all openCompletely open

On a scale of 1–10, how strong is your desire for change and transformation in your life?

Not strong at allVery strong

Are you willing to invest in yourself to become the greatest version of yourself?

Yes No

Which one describes your current level of readiness?

Something in me is ready to move. I need more time before deciding.

When you're facing a significant decision, what tends to help you move forward most?

Understanding the details and knowing exactly what's ahead Trusting your inner feeling that it's right and beginning

Once you complete this, we'll place you where the work will actually help.

Your answers are used only to place you accurately.