Student Graduation Post-Graduation Masters Diploma Certifications Other

Student Not Working Entrepreneur Service Business Other

Energized and light Slow and heavy Anxious and restless Tired and demotivated Mentally active but physically low Other

I like structure and discipline I prefer independence and leadership I am emotional and sensitive I am analytical and curious I enjoy creativity and expression I seek harmony in relationships I like to define myself I am not a morning person Other

Choose at least 1.

Overthinking Emotional reactivity Low motivation Fatigue or burnout Anxiety about the future Difficulty maintaining relationships Other

Difficulty maintaining discipline or routines Relationship conflicts or emotional triggers Career confusion or hesitation in decisions Procrastination or unfinished goals Anxiety or overthinking Feeling stuck despite trying many solutions Other

Choose at least 1.

Anger Fear Anxiety Shame Sadness Helplessness Frustration Sleep Overactive Overeating Reduced appetite Indulgence (drugs/drinking/sex) Hitting others Self harm Guilt I avoid and get busy with chores I seek constant entertainment I avoid people and situations I seclude in spiritualism / prayer Other

Fear of imperfection Fear of failure Fear of rejection Fear of responsibility Fear of judgement Fear of emotional hurt Fear of death Fear of abandonment Other

Yes No Not sure Other

Yes No Other

Yes No Other

Choose 2–6.

Avoids emotional conversations or shuts down Makes me feel my effort is never enough Turns issues back on me — I become the problem Pushes for answers but dismisses what I say Becomes emotionally intense, not solution-oriented Withholds information / selectively open (control) Conversations feel like being evaluated Little to no accountability or closure after conflict I feel drained or inadequate after most talks None of these consistently describe them

Choose 5–7.

I feel I am not chosen or prioritized I feel something is wrong with me I fear people will leave me I struggle to believe I deserve good things I feel I can only rely on myself I feel responsible for fixing others I need control to feel stable I get triggered when things don’t go my way I struggle to trust people I push people away when they get close I feel lost about who I am I overthink most decisions I feel stuck in life or career I struggle to stay consistent I avoid situations where I may fail I delay action waiting for the right time I compare myself with others I feel behind in life I feel emotionally heavy without clear reason I seek validation to feel okay I find it hard to say no I stay in hurtful situations too long I get attached too quickly I struggle to create boundaries I keep quiet to avoid conflict I am quick to judge wrongdoing I feel mostly goalless or purposeless

Choose at least 1.

Light, irregular or easily disturbed sleep Restless, anxious or mentally overactive Acidity or burning sensation Strong, unstoppable hunger Skin rashes, acne or redness Heat in the body, irritability, impatience Sinus congestion, mucus or heaviness Weight gain or water retention Low energy, slow to get started Itchy or dry skin Gas and bloating Hair fall Weak eyesight Brittle or discoloured nails Cracked heels

Choose at least 1.

Knee problem Cervical Severe period cramps Indigestion / gas / bloating Constipation Skin problem Joint cracking Lower back pain Acid reflux Burning stomach Migraines / headaches Sinus congestion Water retention Weight gain Chronic fatigue Insomnia Hair fall Weak eyesight Brittle nails Varicose veins Slip disk Other