Survey for the ‘Inspiring Hope Project’
Based on the book called “Paving the Path to Wellness with Hope”

You will receive $2.00 from the Spiritual Healthcare Network for completing this survey.

Print out the survey below, complete and mail to the address below.

Mail survey to:
The Spiritual Healthcare Network
‘Inspiring Hope Project’ Survey
P.O. Box 1429
Olivebridge, New York 12461

Your responses are greatly appreciated!
They will allow us to hone the way we serve those facing personal challenges.
Mail your completed survey back to the address above for $2.00!
- my appreciation gift to you for completing the survey.


Full Name:______________________________________________
Mailing Address:
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________

Email address:__________________________________________________

Your personal information is needed for the purpose of qualifying and quantifying the data.
It is never shared for any reason.

Please answer all relevant questions below.
It will take you 5-10 minutes to complete.
……………………………………………………………………


1)  How much of the book “Paving the Path to Wellness with Hope” did you read? ___________________________________


2)  What was your Hope Quotient at the beginning of the book? _______________

Using a scale of 1-10 where ‘1’ = No Hope and ‘10’ = Extremely Hopeful,
what is your level of Hopefulness or Hope Quotient now?
_________________


3)  Has your work with Hope contributed to a greater ______ or lesser ______
    sense of well-being? (Please indicate your answer)

If you choose, explain further: ____________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________


4)  On a scale of 1-10 where ‘1’ = no affect and ‘10’ = very positive, how has being more Hopeful
made you feel in regards to your health and healing?  _________

5) If you are feeling better, please answer 5a-5e:
(If you are not feeling better, skip to question 6)

5a) Do you have more Faith today in your ability to heal and get back to your everyday life?  

Yes ______, No _______

If you choose, explain further: _________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________


5b) Are you more convinced that you will recover? 

Yes ______, No _______

If you choose, explain further: _________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

5c) Have you been able to feel more inner peace with what is here now for you?

Yes ______, No _______

If you choose, explain further: _________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________


5d) Do you now feel more capable of making choices that serve your well-being?

Yes ______, No _______

If you choose, explain further: _________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________


5e) Is there a quote or an idea from the book that was particularly significant or helpful to you?

If you choose, explain further: _________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________


6) If you are feeling worse, please answer questions 6a-6e:
(If this section does not apply to you, skip to question 7.)

6a) Do you have less Faith today in your ability to heal and get back to your everyday life? 

Yes ______, No _______

If you choose, explain further: _________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

6b) Are you less convinced that you will recover? 

Yes ______, No _______

If you choose, explain further: _________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________


6c) Have you been unable to feel more inner peace with what is here now for you?

Yes ______, No _______

If you choose, explain further: _________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________


6d) Do you now feel less capable of making choices that serve your well-being?

Yes ______, No ______

If you choose, explain further: _________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________


6e) Is there a quote or an idea from the book that you disagree with and would like to share?

If you choose, explain further: _________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________


7)  If you have had no change in how you feel, please offer some explanation below
and then mail in your survey for your $2.00:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________


8)  Have your personal relationships improved ______ or deteriorated ______?
(Please indicate your answer)

If you choose, explain further: _________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________


9)  Has this work with Hope given you more ways to express your state-of-mind?

Yes ______, No _______

If you choose, explain further: _________________________________________________________
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________


10)  If you would share the nature of your personal challenge(s) here,
this would be appreciated and kept completely confidential.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________


Thank you for taking the time to answer these questions.

Your answers will be of great assistance as the ‘Inspiring Hope Project’
expands to serve more of those in need.