Women Weight Loss Expert

Questionnaire for Free Basic Initial
"Wholistic" Training Assessment

First Name:
Last Name:
Email address:
Street Address:
City, State, Zip:

1. Physical Assessment - Check "Like" or "Dislike" to the following body parts:
Face: Like Dislike	Chest: Like Dislike
Arms: Like Dislike	Back: Like Dislike
Legs: Like Dislike	Butt: Like Dislike
Hips: Like Dislike	Feet: Like Dislike
Belly: Like Dislike	Hair: Like Dislike
Hands: Like Dislike
Where is fat located on your body?

2. Mental Assessment - In few words, define these following concepts:
Body:
Money:
Power:
Communication:
Intuition:
Source:
People:
Work:
Self:
Security:

3. Spiritual assessment - On a scale from 1 to 10 with 1 being the lowest and 10 being the highest, rate your difficulty or ease in the manifestation process:
Health	Responsibility
Wealth	Awareness
Happiness	Relationships
Love	Money
Independence	Work

4. Emotional Assessment - Apply the emotion you feel about the following life events: (Ex: joyful, stressed, fearful, etc …)
Love relationship:	Travel:
Friendship:	Passion:
Family:	Music:
Work:	Health:
Vacation:	You:
Holiday season:
Comments / Questions

Please click "Submit" to send the completed questionnaire to Aline Hanle.
Within 48 hours, you will receive a free basic evaluation as well as a
free mini Wholistic Training Program.

Thank you for your comments! I look forward to hearing from you!