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Wealth Surgery Assessment

Please fill out this Assessment. Once you have filled it out you will receive an email with instructions on how to your Surgery with Dr. Stephania if you haven't already done so. 

Click the button below to start.

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Question 1 of 24

Name: 

Question 2 of 24

Email Address:

Question 3 of 24

Emergency contact name and number

Question 4 of 24

From the list below check as many areas that concern you:

(Select all that apply)
A

Body issues

B

Weight gain

C

Weight retention

D

Aches and pains

E

Fear of being visible

F

Fear of abandonment

G

Fear of rejection

H

Fear of being persecuted

I

Fear of betrayal

J

Fear of humiliation

K

Fear of losing everyone if you have all that you desire

L

Self-sabotage

M

Mother

N

Father

O

Siblings

P

Childhood trauma

Q

Anxiety

R

Depression

S

Fatigue

T

Burnout

U

Lack of libido

V

Money “ceiling”

W

People pleasing/ overgiving

X

Overworking

Question 5 of 24

What results would you most like to get as a result of doing this package? 

Question 6 of 24

How will you know that you got these results?

Question 7 of 24

How will it feel?

Question 8 of 24

What will this bring you in your life?

Question 9 of 24

If you felt completely loved and connected to your Divinity, what would that feel like?

Question 10 of 24

How are things in your life, relationships (and health if applicable) currently? What feels right? What does not feel right? 

Question 11 of 24

Average monthly income (if you want to talk about money) 

Question 12 of 24

Tell me some background around what things were like for you growing up? 

Question 13 of 24

What was your relationship with your parents like? What did they teach you about being worthy of love? Did you feel there were certain conditions on their love, approval, or provision? 

Question 14 of 24

What did they teach you about money?

Question 15 of 24

What did they teach you about God?

Question 16 of 24

What did you learn about being a woman?

Question 17 of 24

What is it like with family now?

Question 18 of 24

Tell me about the person who accepted you the most when you were a kid.

Question 19 of 24

What did you need to hear as a kid? 

Question 20 of 24

What things in your life are you hard on yourself about? What do you feel “not enough” about?

Question 21 of 24

What would it feel like to approve of yourself in every way and truly believe that you are worthy of love and all of your desires? 

Question 22 of 24

If you trusted your intuition implicitly, what would change for you?

Question 23 of 24

If you got that hidden desire in your heart, what would that look like?

Question 24 of 24

Please confirm here that you do NOT have seizures, any form of epilepsy, a pacemaker, heart conditions and are NOT taking anti-psychotic drugs. *

Confirm and Submit