This is a questionnaire by Dr. Joyce Kimble that my chiropractor/boss introduced me to in 1995 and I have used it periodically over the years to help clarify what changes I want to make in my life and to encourage me to make those changes. I encourage anyone who wants to bring about personal change to fill it out honestly and completely and see what happens :-)
1. I want to weigh: 85 pounds less
2. I want to develop the habit of: healthier eating
3. I want to break the habit of: smoking
4. I want to develop the personality habit of: thinking before I speak, especially when my buttons are being pushed
5. I want the following kind of home: harmonious, peaceful, clean, filled with love and laughter
6. I want to make the following improvements in my present home: have clear floor space, unpack and find a place for everything or get rid of it
7. On my next vacation I want to: Scuba Dive
8. I want to communicate with my family in the following ways: kindly, honestly
9. I want to communicate with my coworkers in the following ways: kindly, honestly
10. I want the position of: mediator
11. I want the following kind of office: functional, peaceful, aesthetically pleasing
12. I want to receive the honor of: Nobel Peace Prize
13. I want to have: Marina as a closer friend
14. I want to strengthen my professional skills of: Patience, listening, customer service
15. I want to develop my talent of: Public Speaking
16. I want to solve a particular situation (problem) I have now by: practicing moving meditation
17. I want to eliminate stresses or pressures I now have by: exercising, singing, dancing, laughing
18. I want to make the following specific improvements in my physical condition: healthier lungs, healthier body/weight
19. I want to start the following physical activity: Walking, skipping, dive-rolling
20. I want to acquire the following financial habit: saving money
21. I want to pay on the debts of: tickets from car accident
22. I want to have additional education in: psychology, sociology, anthropology, Spanish & Sign Language
23. I want to do the following for my community: attend and participate in FCAA meetings24. I want to communicate the image of: A strong, Kind, Powerful healer who communicates clearly
25. I want to save: $25 from each paycheck
26. I want to be and do the following in order to influence others in a more positive way: Meet my mentor requirements
27. I want to build up each member of my family by: appreciating them exactly as they are
28. I want to do the following activities with my family: play board/card games
29. I want to develop the spiritual qualities of: peace, serenity, awareness
30. I want to meet the spiritual goals of: practicing meditation daily for 1 year, healing my spirit and body31. Other things I want to happen to me in 6 months: be 30 pounds lighter, be a non-smoker