THE COMPLETE 7-DOMAIN REINVENTION SELF REFLECTION QUESTIONNAIRE

"How Strong Is Your Life Right Now?"

21 questions. 3 minutes. 7 areas of your life. Personalized results.

Get Honest About Where You Are: The first step is radical honesty. Take a moment to rate each area of your life on a scale from one to ten. How do you feel about your physical health? Your emotional state? Your relationships? Your finances? Your sense of purpose and contribution? Don’t judge yourself—just get clear. Awareness is the first step to change.

1. What ONE area of your life would you most like to improve over the next 90 days?

☐ Determining Your Values
☐ Improving Your Physical Health

☐ Improving Your Mindset and Emotional Intelligence
☐ Improving Upon our Career and Business Path
☐ Improving Upon Your Personal Finances
☐ Strengthening Your Relationships (Family, Friends, Dating)
☐ Creating Your Happier Lifestyle and Experiences

1a. What would you most like to change about that area?

[Open text response]

2. What ONE improvement would create the greatest positive impact on the rest of my life?

☐ Determining Your Values
☐ Improving Your Physical Health

☐ Improving Your Mindset and Emotional Intelligence
☐ Improving Upon our Career and Business Path
☐ Improving Upon Your Personal Finances
☐ Strengthening Your Relationships (Family, Friends, Dating)
☐ Creating Your Happier Lifestyle and Experiences

2a. How do you think this improvement will create the greatest impact on the rest of your life?

[Open text response]

3. Rate these core life domains #1 Most important to you today to #7 least important to you today.

☐ Determining Your Values
☐ Improving Your Physical Health

☐ Improving Your Mindset and Emotional Intelligence
☐ Improving Upon our Career and Business Path
☐ Improving Upon Your Personal Finances
☐ Strengthening Your Relationships (Family, Friends, Dating)
☐ Creating Your Happier Lifestyle and Experiences

4. Rate your time investment on these life priorities #1 most time spent to #7 least time spent

☐ Determining Your Values
☐ Improving Your Physical Health

☐ Improving Your Mindset and Emotional Intelligence
☐ Improving Upon our Career and Business Path
☐ Improving Upon Your Personal Finances
☐ Strengthening Your Relationships (Family, Friends, Dating)
☐ Creating Your Happier Lifestyle and Experiences

5. What do you feel your life is missing right now?

Select up to 3:

• ☐ Fun and Excitement

• ☐ Travel

• ☐ A Romantic Partner

• ☐ Friendships

• ☐ Strong family connections

• ☐ Fitness/physical activity

• ☐ I want to feel better

• ☐ I want to look better

• ☐ Confidence

• ☐ Manage my emotions better

• ☐ Spirituality

• ☐ Living with integrity

• ☐ Taking Responsibility

• ☐ Higher Income

• ☐ Less Debt

• ☐ Higher Savings

• ☐ Relaxation

• ☐ Freedom

• ☐ Higher Purpose

• ☐ Different Career

• ☐ Fulfilling Career

• ☐ Prioritize what is important

• ☐ Other(Please Describe )________________________________

6. Rate each Domain from 1–10

1 That life domain is a total disaster.

2-4 Below Average

5-7Average

8-9 Above Average

10 meaning your life is going perfectly in that specific life domain

Domain

Question

Your Values

Do I know what I stand for and what gives my life meaning? Do I take responsibility for my life? What are my priorities? Is spirituality important to you?

Keywords: Honesty, Integrity, Respect, Responsibilities, Beliefs, Purpose, Principles, Contribution, Legacy

Your Physical Health

Do I have the energy, health and physical capability I want? Am I happy with the way I look physically?

Keywords:Health, Fitness, Energy, Appearance, Strength, Stamina, Flexibility, Nutrition, Sleep.

Mindset and Emotional Intelligence

Do you feel satisfied with your life? Are you motivated? disciplined?, focused? Optimistic about your life presently and in the future? Confident?

Keywords: Confidence, adaptable, resilient.

Your Career

Am I doing work that fits who I am and where I'm going?

Do I like the company I work for? Am I respected and appreciated by management? Would I rather be doing something else?

Keywords: Career Transition, Career Mobility, Changing Careers, Changing Companies, Starting a Business, Making more money.

Your Personal Finances

Am I able to save money for the future or in case of an emergency? Are my expenses and debts too high? I am broke. I have financial freedom.

Keywords: Save Money, Expense Management, Spending Plans, Debt Management, Debt Consolidation, Debt Elimination,

Your Relationships

If applicable: Do I have a great relationship with my wife and kids? Are you recently divorced? I need help with dating and finding a romantic partner. I have a good friends that like and support me. I need to have more meaningful friend relationships.

Keywords: Marriage, Parenting, Dating, Romantic Relationships, Friendships, Connections, Bonding.

Your Lifestyle and Experiences

Am I having fun in my life? Do I get to have the life experiences that I would like? Do I have some freedom to have the life experiences I would like?

Keywords: Fun, Experiences, Bucket List, Travel, Reteats, Vacations, Social Groups and Networking, Hobbies, Interests, Learning, Growing, Communities.

1. VALUES REINVENTION SURVEY

VALUES

General Questions: What gives my life meaning? Fulfillment? What do I want to contribute? Who am I and what do I stand for? How do you want to be perceived as a person and as a professional? What are your priorities? Your goals? How do you manage your time related to your priorities?

Also includes: Giving back to your community. Leaving a legacy. The role of spirituality.

Scale (Where applicable):
1 = Very dissatisfied / Not at all true
2 = Dissatisfied
3 = Okay / Could improve
4 = Good
5 = Excellent / Very true

1. I take responsibility for what matters most to me in life.
1 2 3 4 5

2. My daily life reflects my core values.
1 2 3 4 5

3. I have a strong sense of purpose or direction.
1 2 3 4 5

4. I prioritize and invest the time for what I value most in my life
1 2 3 4 5

5. Giving back to my community is important to me?

1 2 3 4 5

6. My spirituality and my relationship with God is important to me?

1 2 3 4 5

7. Leaving a legacy is important to me?

1 2 3 4 5

8. Rate each Core Personal Value on a scale of 1-5

Scale:
1 = Very dissatisfied / Not at all true
2 = Dissatisfied
3 = Okay / Could improve
4 = Good
5 = Excellent / Very true

• Honesty: Speaking and acting with truth and transparency.

1 2 3 4 5

• Integrity: Doing what is right even when no one is watching.

1 2 3 4 5

• Respect

Responsibility: Owning your actions, choices, and commitments.

1 2 3 4 5

• Growth: Learning, adapting, and improving every single day.

1 2 3 4 5

9. I have a clear understanding of who I am and what I stand for?

1 2 3 4 5

10. What would give your life more meaning, purpose or direction right now?(write in)

Score:

6–13: Significant opportunity for reinvention
14–22: Some areas need attention
23–30: Strong foundation

2. PHYSICAL REINVENTION SURVEY

PHYSICAL HEALTH

Overall health, fitness, energy, appearance, less pain, reduced emotional stress, longevity, nutrition, less meds, less doctor visits, capability, sleep, performance. A healthy body provides the physical energy, mental clarity, and emotional stability required to reinvent your life.

Scale:
1 = Very dissatisfied / Not at all true
2 = Dissatisfied
3 = Okay / Could improve
4 = Good
5 = Excellent / Very true

1. I am satisfied with my current level of fitness.
1 2 3 4 5

2. I have the energy and physical ability to enjoy my life.
1 2 3 4 5

3. I feel confident about my physical appearance.
1 2 3 4 5

4. I eat in a way that supports my health and goals.
1 2 3 4 5

5. I consistently get quality sleep (7+ hours per night).
1 2 3 4 5

6. I exercise consistently (At least 3 times per week or more).
1 2 3 4 5

7. Do you consider yourself overweight? If so, ideally how much would you like to lose? (Choose one)

0 lbs

5-10 lbs

11-20lbs

21-30 lbs

31-40 lbs

50+ lbs

8. Rate your estimated or analyzed fat levels (Choose one)

Very fat

Some fat

A little bit of fat

Very little fat

9. Do you have any allergies or health conditions?

Yes

No

9a. Write in (optional)______________________

10. If you could change one thing about your physical health or lifestyle over the next 90 days, what would it be?(write In)

3. MINDSET AND EMOTIONS REINVENTION SURVEY

MINDSET AND EMOTIONS

Mindset, confidence, emotional resilience, self empowerment, learning, growing, challenging yourself, discipline.

The Role of Mind and Emotions (The Engine)

• Mental strategy: Your mind builds the step-by-step plan and focus.

• Emotional drive: Emotions provide the passion and energy to act.

• Daily discipline: Mental habits keep you working when you want to quit.

• Emotional hurdles: Fear or sadness can slow you down, while excitement speeds you up.

Mental Clarity

• Focus: Proper nutrition and rest sharpen decision-making skills.

• Mood: Balanced brain chemistry reduces anxiety and negative self-talk.

• Adaptability: Physical health supports cognitive flexibility for learning new skills.

Emotional Stability

• Confidence: Feeling strong in your physical self boosts self-esteem.

• Stress Management: Exercise releases tension and stabilizes emotional highs and lows.

• Motivation: Physical well-being creates a positive feedback loop for personal drive.

Anger: Signals a threat, injustice, or a need to defend boundaries.

Fear: Alerts the brain to danger and triggers survival or avoidance responses.

Sadness: Responds to loss or disappointment and prompts a need for comfort.

Disgust: Rejects harmful or toxic substances and experiences.

Joy: (Happiness): Reinforces beneficial social bonds and experiences.

Surprise: Responds to unexpected shifts in the environment.

Scale:
1 = Very dissatisfied / Not at all true
2 = Dissatisfied
3 = Okay / Could improve
4 = Good
5 = Excellent / Very true

1. I am focused on my life goals and I don’t waste time paying attention to things that doesn’t help achieve my goals?

1 2 3 4 5

2. I do not procrastinate and follow through on my daily tasks and achieving my life goals

1 2 3 4 5

3. I am disciplined and consistent on creating a better life for myself

1 2 3 4 5

4. I do not let challenges and roadblocks stop me from achieving my goals

1 2 3 4 5

5. I am depressed and ashamed about how my life has turned out

1 2 3 4 5

6. You are hopeful about the present and/or your future

1 2 3 4 5

7. I let my mood and emotions impact how I feel day to day

1 2 3 4 5

8. I feel that my life is meaningful and worthwhile.
1 2 3 4 5

9. I consider myself to have a high self-esteem

1 2 3 4 5

10. I feel highly motivated by my life.
1 2 3 4 5

Score:

6–13: Significant opportunity
14–22: Room for improvement
23–30: Strong foundation

CAREER REINVENTION SURVEY

Work, business, purpose, professional reinvention, career transition. Finding purposeful work or running a business that aligns with your passions.

Your career acts as the main engine for reinventing your life because the work you do shapes your daily routine, identity, and financial security.

Scale:
1 = Very dissatisfied / Not at all true
2 = Dissatisfied
3 = Okay / Could improve
4 = Good
5 = Excellent / Very true

1. I am satisfied with the direction of my career.
1 2 3 4 5

2. I work more than one job just to cover living expenses
Yes No

3. I am earning what I believe I am worth.
1 2 3 4 5

4. I like the company that I work for.

1 2 3 4 5

5. I receive recognition and appreciation from management for the work I do.

1 2 3 4 5

6. I like my co-workers.

1 2 3 4 5

7. How many hours are you at work per week?

Less than 20

21-30

31-39

40-49

50+

60+

70+

8. You are fearful that you will be laid off or fired

1 2 3 4 5

9. I am motivated to leave my company, change careers or start my own business?

1 2 3 4 5

10. If you could change one thing about your career or professional life, what would it be (write in) ?

Score:

6–13: Significant career opportunity
14–22: Career needs attention
23–30: Strong career foundation

FINANCIAL REINVENTION SURVEY

Personal Finances— income, wealth, financial security, debt management, financial freedom, independence, budgeting, priorities.

Creating Options and Freedom

• Buying time: Savings let you quit a bad job or leave an unhappy situation safely.

• Reducing fear: Cash reserves mean you can plan your next step without panic.

• Opening doors: Extra funds help you pay for new classes, tools, or a career shift.

Building Stability

• Emergency funds: Money saved for surprises keeps one bad event from ruining your fresh start.

• Clearing debt: Getting rid of old loans stops past mistakes from draining your future income.

• Setting boundaries: Sticking to a budget helps you focus on what truly matters now.

Changing Mindsets

• Taking control: Managing your money teaches you how to manage your daily choices.

• Stopping waste: Cutting unneeded buying shows you how to find joy in simpler things.

• Growing value: Smart investments turn today's hard work into tomorrow's safety net.

Scale:
1 = Very dissatisfied / Not at all true
2 = Dissatisfied
3 = Okay / Could improve
4 = Good
5 = Excellent / Very true

1. I can cover at least 3 months of your total living expenses if something catastrophic happened to me.

1 2 3 4 5

2.I have a clear understanding of where my money goes each month.
1 2 3 4 5

3. My income and financial strategy support the life I want.
1 2 3 4 5

4. I feel confident about my long-term financial future.
1 2 3 4 5

5. I am making meaningful progress toward financial independence.
1 2 3 4 5

6. How much total personal debt do you carry including credit cards, personal loans, health payments for emergency and surgery, back tax payments, and car payments. Do not include real estate such as your mortgages, and business loans and other business debts?

$0

Under $500

$500-$999

$1000-$5000

$5001-$10,000

$10k-$50k

$50k-$100,000

$100k+

7. What % of you income goes towards the following items?

Housing mortgage and rent_____%

Grocery and household goods_____%

All personal debt payments credit cards, personal loans, tax payments, payment plans, car payments_%

Utilities __%

Internet__%

Apps and subscriptions___%

House cleaning service___%

Storage___%

Repairs car home etc___%

Personal or significant other entertainment: lunches, dinners, breakfasts, Nights outs, travel, movies, days out, not including family outings and entertainment, cable TV, streaming services___%

Insurances___%

Family expenses (Children’s activities, Family entertainment, etc.

Miscellaneous (write-in) ___%

8. I avoid looking at and reviewing my debts and expenses because it seems too overwhelming and depressing.

1 2 3 4 5

9. I am embarrassed about my financial situation.

1 2 3 4 5

10. One final question:

What is the biggest financial improvement you'd like to make over the next 12 months (write in)?

Score:

6–13: Significant financial opportunity
14–22: Financial situation needs attention
23–30: Strong financial foundation

RELATIONSHIPS REINVENTION SURVEY

Relationships — family, friendships, dating, intimacy, connection, your network, who do I want around me, where do I belong, how high is the priority.

Emotional Support and Resilience

• Stress buffer: Supportive people help lower your stress and reduce anxiety during major life changes.

• Safe haven: A trusted confidant gives you a safe space to process fears and failures without judgment.

• Validation: Knowing someone believes in you builds the confidence to step outside your comfort zone.

Personal Growth and Expansion

• New perspectives: Friends and partners introduce you to new ideas, skills, and habits that broaden your identity.

• Mutual empowerment: Collaborating with uplifting people inspires creativity and keeps you accountable to your new goals.

• Challenging limits: Healthy connections push you to confront self-doubts and grow beyond your previous limits

Scale:
1 = Very dissatisfied / Not at all true
2 = Dissatisfied
3 = Okay / Could improve
4 = Good
5 = Excellent / Very true

1. I am (choose one):

Single

In a relationship

In a relationship with children

Married no children

Married with children

Divorced

2. I have strong relationships with the people closest to me.
1 2 3 4 5

3. I prioritize enough time for the people who matter most.
1 2 3 4 5

4. I invest quality time with my wife and significant other exclusively (together without other family, children, or friends)

1 2 3 4 5

5. I handle family conflict in a healthy and productive way.
1 2 3 4 5

6. I invest time regularly to get together or connect with my immediate family (My Father, My Mother, My Siblings, Aunts, Uncles, Cousins, Nieces, Nephews, etc.).

1 2 3 4 5

7. I have meaningful friendships and relationships outside my family.
1 2 3 4 5

8. I have people I can genuinely talk to when life gets difficult.
1 2 3 4 5

9. I regularly go out on dates with different people.
1 2 3 4 5 N/A

10. I regularly go out on dates with the intention of having a committed romantic relationship.
1 2 3 4 5 N/A

11. I regularly go out on dates with the intention of having fun and meeting new people.
1 2 3 4 5 N/A

12. I am having fun with dating

1 2 3 4 5 N/A

13.

What aspect of your relationships would you most like to strengthen (write in)?

Score:

6–13: Significant opportunity
14–22: Relationships need attention
23–30: Strong foundation

LIFESTYLE AND EXPERIENCES SURVEY

Lifestyle and Experiences — adventure, recreation, environment, fun and enjoyable experiences, where do you want to live geographically.

Breaking Autopilot and Routines

• Escaping daily repetition: Staying on mental autopilot makes time fly and dulls personal growth.

• Forcing attention: Trying novel activities forces the brain to pay attention rather than rely on old habits.

• Creating milestones: Distinct activities give your memory fresh reference points for a new chapter in life.

Triggering Brain Plasticity

• Building connections: Engaging in unfamiliar hobbies promotes neuroplasticity (the brain's ability to form new neural connections).

• Releasing dopamine: Novelty activates the brain's reward pathways, boosting mood and internal motivation.

• Sharpening focus: Learning a new physical or creative skill improves long-term mental clarity and cognitive adaptability.

Fostering Emotional Reset

• Lowering stress: Recreation lowers stress hormones like cortisol that trap people in fatigue or burnout.

• Processing emotions: Physical exertion or artistic expression provides a healthy outlet for stored emotional tension.

• Restoring perspective: Stepping away from ordinary obligations lets you "re-create" your mindset before tackling major life decisions.

Rebuilding Identity and Confidence

• Testing capabilities: Trying unfamiliar tasks reveals hidden strengths and expands personal limits.

• Embracing vulnerability: Stepping outside your comfort zone as a beginner builds courage and self-worth.

• Connecting with others: Group-based recreation builds new social support systems that reinforce a fresh identity.

Scale:
1 = Very dissatisfied / Not at all true
2 = Dissatisfied
3 = Okay / Could improve
4 = Good
5 = Excellent / Very true

1. I am satisfied with my lifestyle right now

1 2 3 4 5

2. I am not afraid and open minded to try something new

1 2 3 4 5

3. How often do you do things that genuinely excite you?

1 = Never/Rarely
2 = Sometimes
3 = Often
4 = Very often

1 2 3 4

4. I am too busy and too tired to be able to participate in outside experiences and activities

1 2 3 4 5

5. How often do you find yourself looking forward to something?

1 = Never/Rarely
2 = Sometimes
3 = Often
4 = Very often

1 2 3 4

6. How often do you make time for yourself and the things you enjoy?

1 = Never/Rarely
2 = Sometimes
3 = Often
4 = Very often

1 2 3 4

7. My current lifestyle reflects the person I want to be.

1 2 3 4 5

8. I belong to a community that has similar interests and I can share my experiences with
1 2 3 4 5

9. If money, time, or other obligations weren't holding you back, what would you do more of?

Write-In

10. What would make your life more exciting, enjoyable, or fulfilling right now?

Open response

YOUR SCORING SYSTEM

Each domain has a maximum score of 15.

Score

Interpretation

3–6

Major Reinvention Opportunity

7–10

Needs Attention

11–13

Solid but Could Improve

14–15

Strong

Then create a simple prospect report:

YOUR REINVENTION SCORE

Spiritual: 8/15
Physical: 6/15
Intellectual: 12/15
Career: 7/15
Financial: 5/15
Family: 13/15
Social: 8/15

Overall Score

59/105

Highest-Priority Areas

#1 Financial — 5/15

#2 Physical — 6/15

#3 Career — 7/15