Please print this page, complete the 2 forms and return to me via email.
Contact: mail@spiritdoula.net
Your Spirit Helpers (form 1)
Please rate each statement as you know it to relate to you
0 (does not apply) to 5 (most relatable)
1. I feel the pain of others very strongly
0 1 2 3 4 5
2. I protect others and loudly protest disrespect
0 1 2 3 4 5
3. I stand for those who cannot stand for themselves
0 1 2 3 4 5
4. I begin creative projects, but often do not complete them
0 1 2 3 4 5
5. I am a steward of our planet
0 1 2 3 4 5
Name___________________________
Date___________________________
Spirit Doula Assessment (form 2)
Please answer each question based upon your comfort level
1 (strongly disagree) to 5 (strongly agree)
1. I am self actualized
1 2 3 4 5
2. I go to meditation often for self reflection
1 2 3 4 5
3. I communicate easily with my spirit helpers
1 2 3 4 5
4. I have made peace with my personal past
1 2 3 4 5
5. I am ready to allow change into my life
1 2 3 4 5
Total of form 2 numbers only__________________
Name_________________________
Date__________________