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The Mindset Questionaire

Fill out this questionnaire for some self-reflection to see if your mindset is what's holding you back. At the end you'll have an opportunity to book a free mindset discovery call with Dana Lee to talk about what steps you can take from here.

Click the button below to begin.

Start

Question 1 of 13

First and Last Name:

Question 2 of 13

 Your Best Email:

Question 3 of 13

When it comes to eating what is the single biggest challenge, frustration or problem you've been struggling with and how long has it been a struggle? (Please be as specific & detailed as possible)

Question 4 of 13

When it comes to working out what is the single biggest challenge, frustration or problem you've been struggling with and how long has it been a struggle? (Please be as specific & detailed as possible)

Question 5 of 13

Have you read any books or participated in any programs that you would consider Mindset Work?

A

Yes

B

No

Question 6 of 13

If so, please list the books read and/or programs you've participated in.

Question 7 of 13

Are you trying to follow a particular workout plan now?

A

Yes

B

No

Question 8 of 13

If yes, what outcome are you hoping to achieve from it?

Question 9 of 13

Choose the answer that best describes you:
When I work out, I:

A

Love it - give me more!

B

Endure it - I love the results but wish I didn’t have to work so hard to get them

C

Can’t wait ‘til it’s over - I’ll use any excuse to skip my workout on any given day

D

I don't currently work out

E

I am an on-again / off-again type of exerciser

Question 10 of 13

Select all the things you do on a daily basis (4- 5 times per week).

(Select all that apply)
A

Journal

B

Meditate

C

Affirmations

D

Workout

E

Reward myself with something I love (non-food)

F

Get 8 or more hours of sleep each night

G

Spend time doing something just for me

H

None of the above

Question 11 of 13

Check all that you can identify with:

(Select all that apply)
A

I've been in a lengthy battle with the bathroom scale.

B

The number on the bathroom scale can affect my mood or sense of self-worth.

C

I believe I'll finally be happy and love my body once I reach an "ideal" bodyweight or specific body measurements.

D

I can't remember the last time you weren't trying to lose fat.

E

I think it's important to finish every workout feeling totally exhausted.

F

I've performed workouts as punishment for overindulging or skipping a workout earlier in the week.

G

I've performed a workout to "earn" the right to eat dessert or my favorite meal or second helping.

H

I determine the value of a workout based on how sore I am the next day.

I

I've been "hating my way" to a lighter/leaner/shapelier body (i.e., you think disliking parts of your body you want to "fix" is good motivation to work hard).

J

Activities I once did for enjoyment (biking, going for a walk, hiking, jogging) are now activities I make yourself do solely for the calorie burn.

K

I wish I knew what it was like to look forward to and enjoy my workouts.

L

I want my workout regimen to help me feel good about myself.

M

I've never known any reason to strength train or move a my body apart from the calorie burn or fat-loss potential.

N

I crave a change of pace, a proverbial "breath of fresh air" with my food plan and/or my fitness regimen.

Question 12 of 13

If you enrolled in a Mindset Program, what outcome would you need to have to make it work your time, energy, effort and money? In other words, if I could wave a magic wand over you, what would you want to magically change on the other side? How would you want to FEEL?

Question 13 of 13

Is there anything else you'd like to share?
Or, do you have questions for Dana Lee to answer for you?

Confirm and Submit