Khatri, Mitesh

Date With Destiny

Phone: 9011061605
Cairns | MAY 20 - MAY 25, 2019
Email Address: miteshdell@gmail.com

Date with Destiny Questionnaire

Consent prior to collection of Sensitive Personal Data

Robbins Research International sometimes requests health and other sensitive

personal information about you in order to evaluate your fitness and ability to
participate safely in our live events, and to assist us and you in determining
what goals and aspirations you seek to fulfill through our events. By clicking “I
Agree” you consent to our collection and use of the information requested to
evaluate you for purposes of your participation in our live event, and other
purposes as set forth in our Privacy Policy. If you prefer that we do not collect
and process this information then you may not be able to participate in this
event.
This question has not been answered

Why are you attending Date With Destiny?

What motivated you, or what is your compelling reason, for attending Date With
Destiny?
This question has not been answered

Describe the one thing you most want to learn, change, or reinforce.
This question has not been answered

How will you know if you have achieved your outcome from this program?
This question has not been answered

What are some of your goals for the next 12 months?

PAGE 1 05/12/19
This question has not been answered

What has your life been about so far?

What has been your primary focus in life? Where have you put the most time
and energy?
This question has not been answered

Please Describe 4 events that have shaped your life

First life-shaping event and what you learned

This question has not been answered

Second life-shaping event and what you learned

This question has not been answered

Third life-shaping event and what you learned

This question has not been answered

Fourth life-shaping event and what you learned

This question has not been answered

What are the beliefs that have shaped your life?

What are some of your most important beliefs about life?(ex. Life is good , life is
a struggle, life has no meaning, life is what you make of it)
This question has not been answered

What do you believe is within your control? What are you responsible for? What
is out of your control?
This question has not been answered

PAGE 2 05/12/19
What do you believe about relationships (with a significant other, family, friends,
associates)?
This question has not been answered

Who do you believe you are? How would you identify yourself? If you had to
describe yourself to someone else, what would you say?
This question has not been answered

What do you have certainty about in your life?

This question has not been answered

What are you uncertain about?

This question has not been answered

What is most important in your life?

This question has not been answered

What is great in your life today? What are you excited about? What are you
proud of?
This question has not been answered

What is missing in your life? What will it take for you to get or experience what
you want?
This question has not been answered

What typical resourceful and unresourceful emotions do you

experience in a week?

Make a list of at least 10 Resourceful Emotions

This question has not been answered

Make a list of at least 10 Unresourceful Emotions

PAGE 3 05/12/19
This question has not been answered

Please describe typical emotional triggers and your responses

First resourceful emotion: Choose a resourceful emotion from the list you have
created, then describe a typical situation that triggers this emotion, and what
you do (if anything) to make the emotion better.

Example: Emotion: Love

Situation: When I see my child
Trigger: Her Smile
Enhancer: I tickle her and we both laugh
This question has not been answered

Second resourceful emotion: Choose another resourceful emotion from the list
you have created, then describe a typical situation that triggers this emotion,
and what you do (if anything) to make the emotion better.
This question has not been answered

First unresourceful emotion: Choose an unresourceful emotion from the list you
have created, then describe a typical situation that triggers this emotion, and
what you do (if anything) to make the emotion go away.

Example: Emotion: Overwhelm

Situation: When my boss asks for a project I haven't finished yet
Trigger: Hearing his voice
Eliminator: I go outside and take 10 deep breaths
This question has not been answered

Second unresourceful emotion: Choose another unresourceful emotion from

the list you have created, then describe a typical situation that triggers this
emotion, and what you do (if anything) to make the emotion go away.
This question has not been answered

What emotions do you value or avoid?

PAGE 4 05/12/19
In what areas of your life do you experience the most stress? What creates that
stress (be specific)?
This question has not been answered

How do you get out of stress? What coping mechanisms do you use to feel
better? And how well does each of them work?
This question has not been answered

What emotions and behaviors do you experience on a regular basis that you
would like to change or eliminate?
This question has not been answered

What are some of the things you do to make yourself feel great? What makes
you feel really, really good?
This question has not been answered

If you could have your life exactly the way you want it, how would it be?
This question has not been answered

What are you most grateful for in life?

This question has not been answered

Why are you attending Date With Destiny?

Have you watched the Netflix original documentary “Tony Robbins: I Am Not
Your Guru”?
This question has not been answered

Did watching or hearing about the documentary play a part in your decision to
enroll in this event?
This question has not been answered

PAGE 5 05/12/19