SESSION PREPARATION WORKSHEET

Request and Prep for Your Complimentary
THRIVE BLUEPRINT Call

I'm dedicated to helping high-integrity, passionate partners restore the love, trust, respect, and deliciousness to their romantic connection.

I'm here to support you in discovering your next step to developing consistent access to your authentic, values-driven clarity, confidence, and Life-aligned power ... so that you can create, repair, and sustain what matters most in your life, your work, and your important relationships.

During our time together we'll explore what's going on, the strengths you bring to the challenges you're facing, and how I might be able to create extraordinary shifts in your understanding and mastery.

And if what I offer isn't the right "fit" for you at this time, I'll recommend other resources that might offer the support you need right now.

As you complete this form, please take a few moments to mindfully consider what isn't working for you right now, and what you're longing for, instead.

Most people find this process greatly clarifying, inspiring, and supportive, in and of itself. I hope it serves you well.

We're born to thrive ... together.

Come discover a powerful, ease-filled pathway to claiming and living your birthright of deeply satisfying, passionate, thriving relationships.

It's a privilege for me to explore what's next for you, as you chart a course to your own fulfillment on that journey.

P.S. I'm currently based in Minneapolis, Minnesota (US Central Time).
Request and Prep for Your Complimentary
THRIVE BREAKTHROUGH Call

I'm dedicated to working with high-integrity, visionary leaders who're committed to restoring humanity's sustainable, honoring connection with ourselves, each other, and the Community of Life on Earth.

I'm here to support you in discovering your next step to developing consistent access to your authentic, values-driven clarity, confidence, and Life-aligned power ... so that you can create, repair, and sustain what matters most in your life, your work, and your important relationships. (Which might or might not include working with me. What's most important is identifying whatever could set you free. It doesn't have to be me!)

Please take a few moments to mindfully consider what isn't working for you right now, and what you're longing for, instead.

Most people find this process greatly clarifying and inspiring, in and of itself. I hope it serves you well.

We're born to thrive ... together.

Come discover a powerful, ease-filled pathway to claiming and living your birthright.

It's a privilege for me to explore what's next for you, as you chart a course to your own fulfillment on that journey.

P.S. I'm based in Minneapolis, Minnesota (US Central Time).
Congratulations on taking the next step to get your Survival Self out of the driver's seat and revolutionize your romantic relationship in the next 16 weeks.

Complete these questions now to claim your spot, get refreshing new clarity, and begin your transformational journey toward a truly extraordinary relationship.
**Your answers are required within 24 hours of booking your Revolutionary Relationship Blueprint Session. If not, your spot will be released for someone else.**

What to Expect in Your Session

During this no-cost, 1-on-1 session you'll receive high-level support to: 1) Identify which of the foundations of Revolutionary Relationships your Survival Self is undermining/sabotaging/interfering with. 2) Illuminate your most powerful pathways to get and keep your Survival Self out of the driver’s seat of your relationship. 3) NEED TO ADD a 3RD THING.

2) Identify potential obstacles to your success. 3) Prioritize your next steps to achieve your revenue goals. You will also learn how our approach helps you achieve consistent visibility and revenue as you customize your unique Frequency Factor™ Framework.

Who Should Apply

This session is ideal for high-integrity men and women who are committed to extraordinary romantic relationship that profoundly contributes to both partners’ thriving.

Session Fit: The Revolutionary Relationship Blueprint Session is for you if:

- Both your own and your partner's well-being deeply matter to you. This means if something important has to change in order for both of you to be able to truly thrive in your relationship, you would be willing to make that change.

- You're dedicated to honoring your own values, as well as respecting your partner's values. (Note: Respecting your partner's values doesn't mean liking or agreeing with them. It does mean honoring their right to have them, and being willing to seriously consider them when making choices about your relationship.)

- You're ready to invest time, energy, attention, and money to create real, revolutionary change in your romantic relationship.

It is not suitable if you:

- Are not fully committed to creating an extraordinary romantic relationship that works beautifully for you both.

- Are not willing to enjoy a significant transformation in your relationship right now.

**Note:** This is not an invitation to work with us. If our Revolutionary Relationship Roadmap seems like a fit, we'll share more about what it looks like when we work together.

If you're unsure if you meet these criteria, do complete the questions for greater clarity and [IN MY OWN WORDS: accelerated growth].

Our Commitment: We offer resources and provide suggestions that will help you revolutionize your relationship and regain real safety and respect, intimacy, and amazing, luminous connection with your partner. We will open as many spots for these sessions as possible.
To get the most out of your Session, I invite you to complete this Session Preparation Worksheet.

Most people find this preparation tremendously illuminating, empowering, and valuable.
First Name:*
Last Name:*
E-mail*

Confirmation Emailexample@example.com
City:*
State/Province:*
Country:*
What is your Time Zone? Please use current UTC, if outside the US.
Phone Number with Country Code (country code=1 for USA & Canada)*

Country CodeArea CodePhone Number
Please re-enter your phone number (X-XXX-XXX-XXXX).*
Can you receive texts at this number?*

YesYes, but only for special situationsNoOther (specify here)
What kind of Session are you preparing for?

Exploration SessionRelationship Alchemy Blueprint Session
IMPORTANT NOTE:

You can SAVE THIS FORM and come back to it later.

Scroll to the bottom for instructions.
All that you share with me will be kept strictly confidential.
How did you FIRST hear about Vika or Thriving Life?

Met Vika in personFrom a Friend, Family Member, Neighbor, Colleague, Therapist, etc. (please specify below)Internet Search to Thriving Life Website (Google, Yahoo, Ask, etc.)Internet Search to some other site (please specify below)Thriving World Project Facebook page (thrivingworldproject)Vika's Instagram Page (realvikamiller)Meetup GroupReceived a Thriving Life emailCNVC WebsiteORNCC WebsiteORNCC NewsletterSacred Circle Dance listOther (please specify)
Who referred you to Vika or Thriving Life?
Have you participated in a live Thrive Roadmap Essentials Seminar (online or in person), or the recorded Thrive Roadmap Essentials (formerly Thriving Fundamentals) Interactive Video Program yet?*

Yes, a live Thrive Roadmap Essentials SeminarYes, I've completed the online Thrive Roadmap Essentials (formerly Thriving Fundamentals) Interactive Video Program (approx. 2 hours, www.thriving-life.org/thrive-roadmap-essentials)Not yet, but I'm planning toI don't know / I don't currently have plans for that
What are the most helpful things you learned from the Thrive Roadmap Essentials?*

0/0
Have you watched these essential Thriving World videos, yet? (please check all that apply)*

The 3 Key Secrets that Turn Stress & Pain into Health & HappinessHow Our "Broken Toes" Sabotage Our Relationships
What are the most helpful things you learned from the "3 Key Secrets" video?*

0/0
What are the most helpful things you learned from the "Broken Toe" video?*

0/0
Have you had any experience with:*

Nonviolent/Compassionate Communication (NVC)Neuroscience, especially as it relates to trauma and reactivityAttachment TheoryInner Parts Work or Internal Family Systems (IFS)Somatic EmpathySomatic Process WorkNone of these
Please share a bit about your NVC education, practice, and experience.*
What is it about Vika or Thriving Life that has you interested in exploring the possibility of working with her in particular? Please be as specific as possible.*
What type of issue are you hoping to receive support for, in your upcoming Session?

Personal - Stress, Anxiety, Self-Doubt/Second-Guessing, Procrastination/Paralysis, Trouble Sleeping, Brain Fog (etc.)Personal - Performance at WorkRelationship (any kind)Other (please specify)
Please specify what "Other" type of issue you're hoping to receive support for, in your upcoming Session.
NOT IN USE: What type of issue are you hoping to receive support for, in your upcoming Session? (Please check ONLY ONE.)*

Personal - Stress, Anxiety, Procrastination, Trouble Sleeping, Brain Fog (etc.)Personal - Performance at WorkRelationship (any kind)Other (please specify)
Please clarify the kind of relationship you have with the other person:*

DatingDating and considering "getting serious" in some wayCurrent Romantic PartnerFormer Romantic PartnerParent (the other person is your adult child)Adult Child (the other person is your parent)Adult Sibling (you and the other person are adult siblings)Other Adult Family MemberBusiness Partner or Client (current, past, or prospective)Boss/SupervisorCoworkerNeighborTeacherClassmateFriendOther (please specify)
Please share a bit about your current romantic relationship: How long have you known each other? How long have you been romantically involved? Do you live together? Do you and/or your partner have children? If yes, how old are they?*
Please share a bit about your former romantic relationship: How long have you known each other? How long were you romantically involved? How long has it been since you stopped being romantic partners? *
If any of your challenges involve the children in any way, please also share: If they don't live with you full time, what is their schedule with you? Are there any issues with their other parent or other caretaker(s) that affect your relationship with your romantic partner?
Please share a bit about your relationship: How long have you known each other? How long have you had some issues or concerns? *
What SPECIFIC situation, issue, or concern are you wanting to address?*
Briefly describe a SINGLE, SPECIFIC interaction or incident that happened, that offers a CLEAR EXAMPLE of this situation, issue, or concern. *
What was it about that, that bothered you? What was so "wrong" about it? (Please share what comes up for you, even if it seems obvious.)*
What resources or support have you tried so far, to help you address or resolve this situation, issue, or concern? (For example: reading self-help books; personal or relationship coaching; personal or relationship counseling/therapy; specific treatment modalities; relationship workshops; etc.)*
Are you currently using any of these resources? If yes, which ones?*
How did that work for you?
What has been MOST helpful to you, or what REALLY WORKED for you, about any of these past or current resources? (Please identify the specific resources that contributed to that help.)*
What has been LEAST helpful to you, or what DIDN'T work for you, about any of these past or current resources? (Please identify the specific resources that have contributed to that help.)*
OVERALL, what are the most helpful things you've LEARNED so far, that have made a SIGNIFICANT DIFFERENCE for you regarding this situation, issue, or concern (if any)?*
Right now, what are your biggest challenges when it comes to this situation, issue, or concern? What are your biggest problems with it, or your greatest concerns about it?*
What is not resolving this situation, issue, or concern costing you? (E.g., with regard to your peace of mind, confidence, ability to concentrate, or behave according to your values, as well as your energy, stress, health, money, relationships, etc.)*
How satisfied or happy are you with this situation, issue, or concern, right now?*

1

2

3

4

5

6

7

8

9

10

1 is Extremely Unsatisfied/Unhappy, 10 is Extremely Satisfied/Happy
How okay would it be for you, if this situation, issue, or concern never changed?*

1

2

3

4

5

6

7

8

9

10

1 is Completely Intolerable, 10 is Completely Wonderful
What would or are you considering doing, if this situation, issue, or concern NEVER changes?*
How much longer are you willing to have things stay the way they are? By when are you committed to making sure you've created a significant change in this issue or circumstance?*
What do you REALLY want instead? Please be as specific and detailed as possible, addressing both your inner life (feelings, qualities, well-being, etc.) and your outer life (circumstances, events, resources, relationships, etc.).*
What would your life be like, if you were able to get what you REALLY wanted, with regard to this issue or circumstance? Please be as specific and detailed as possible, addressing both your inner life (feelings, qualities, well-being, etc.) and your outer life (circumstances, events, resources, relationships, etc.).*
On a scale from 1-10, how committed are you to getting what you REALLY want, in this part of your life?*

1

2

3

4

5

6

7

8

9

10

1 is Not At All Committed, 10 is Extremely Committed
In what ways do you regularly nourish your well-being? (E.g., eating well; exercise and movement; attuned connection with friends and/or family; attuned connection with yourself; spiritual connection with Life/Source/Universe (or whatever term speaks to you); enjoyable and meaningful creativity, including paid work; rest and fun/play; etc.)*
How often do you devote time and effort to your self-care?*

Every day4-6 days a week2-3 days a weekAt least 1 day every weekI'm not there yet, but I'm working on itI'm not there yet, but that's part of what I want to change and why I'm exploring working with youOther
What is your occupation (or if retired, what was your occupation)?*
How many total hours a week do you work?*

None, I'm retiredUp to 30 hours31 to 40 hours41 to 50 hours51 to 60 hoursMore than 60 hours
On a scale from 1-10, over the past 90 days, how much have you enjoyed your work? (If you're retired, how much did you enjoy the last 5 years of your work, overall?)*

1

2

3

4

5

6

7

8

9

10

1 is Not At All (every day is a burden), 10 is Completely (it's a dream come true)
How many drinks do you typically have?*

I don't drink alcohol1-2 drinks per month (4-8 drinks per month, total)1-2 drinks per week (4-8 drinks per week, total)1-2 drinks per day3 or more drinks per dayOther
Do you use cannabis (marijuana)?*

I don't use cannabis1-2 uses per month (4-8 uses per month, total)1-2 uses per week (4-8 uses per week, total)1-2 uses per day3 or more uses per dayOther
What substances or activities do you most often use to soothe yourself, when you're worried or stressed? (E.g., reading, TV with commercials, TV without commercials, movies, music, video games, shopping, sex, physical activities/sports, alcohol, cannabis, work, online solitaire games (like Wordle), etc.)*
If your investment of time, attention, energy, effort, and dollars could create SIGNIFICANT improvement in this area of your life within the next 1 week to 3 months, what TIME BUDGET would you be willing and able to invest PER WEEK to make that happen? (This information allows me to begin considering what combination of Thriving Life or other resources and programs might be the best "fit," to help you reach your goals within your commitment and available resources.) *
If your investment of time, attention, energy, effort, and dollars could create significant improvement in this area of your life within the next 1 week to 3 months, what DOLLAR BUDGET would you be willing and able to invest PER WEEK to make that happen? (This information allows me to begin considering what combination of Thriving Life or other resources and programs might be the best "fit," to help you reach your goals within your commitment and available resources.) *
If you could get some immediate relief during your Blueprint Call, what SPECIFIC CHALLENGE or DISRUPTION would you most like to get relief from during our time together?*
What's the #1 change you want to see in your relationship, within the next 4 months?*
If you had a powerful pathway to make this change, when will you be ready and willing to invest in support to make it happen?

Now3-6 months1 year or more
SCHEDULING LOGISTICS
Your Thrive Breakthrough Consult is provide by Zoom video conference. Do you have any concerns or limitations related to this?*

Zoom works fine for meZoom works for me technically, but I have issues with seeing my own image on the screenZoom doesn't work for me technically, I can only connect by phone
What hours are you usually available for sessions, Sundays through Saturdays? Feel welcome to omit times and days of the week when you would NEVER wish to do a session. (Please kindly translate to US CENTRAL time zone.) NOTE: I don't keep a regular schedule and can be available any day of the week.*
Most Thrive Breakthrough Calls are offered between 1pm and 6pm US CENTRAL, which is 1 hour earlier than Eastern/New York Time, and 8 hours earlier than GMT-0/London Time.

If you require a time outside of this 1pm-6pm US Central time window, you're welcome to make a specific request for that.
If we haven't already scheduled a session, please offer 3 times (using US CENTRAL time) on 2 or 3 different days during the next week, when you'd be available for your Thrive Breakthrough Consult. (If we've already scheduled your Consult, please enter that appointment information here.)*
Is there anything else you'd like me to know, or is there anything you'd like to ask?
**************************************

.

Thank you for all you've shared!

I look forward to clarifying together, what can make a powerful difference for you on your journey.

Holding you with respect and care until we connect,

Vika Miller, Steward
Thriving World Community
www.thrivingworldcommunity.org
You can SAVE YOUR FORM and come back to it later.

*You do not have to sign up for anything with Jotform to do this.*

When you see Jotform's message "Sign up to save submission as draft"
look at the bottom of that pop-up and select "Skip Create an Account."
Should be Empty: