Yoga Sadhana Assessment Form |
Do you face any physical health challenge which affects you in your day to day activities ? Select the option most applicable to you |
Yes something troubles me all the time throughout the day |
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Yes it disturbs me everyday |
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Yes it disturbs many times, if not everyday |
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No there is nothing |
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Remarks :
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Do you face any physical health challenge by which you are not affected in day to day life but concerned about |
Yes if I neglect it can be of serious concern |
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Yes if I neglect it may cause some issue in future |
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Its not a concern but It is something which I want to improve |
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No there is nothing |
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Remarks :
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How much of your attention is towards your physical body ? |
I am always concerned about it anywhere anytime |
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Mostly I am not so concerned |
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I am concerned during special occasions |
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I am concerned when I have to be with people |
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Remarks :
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How do you rate your food content input according to your body requirement ? |
I am meticulous about what and how much I eat |
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I have decided to follow diet but unable to do so |
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I give myself liberty whenever I think I deserve |
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I eat whatever (including non-home) food and as much as I feel like |
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Remarks :
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How much disciplined are you in following the right time for food ? |
I dont follow any fixed time of eating |
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I want to but cant eat at regular time due to work and other issues |
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I have regular routine but cant say that it is healthy (eg daily late dinner) |
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I have regular healthy routine of eating |
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Remarks :
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Do you know what enhances /depletes your energy ? |
Yes I can sense the deviation in my energy / prana |
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I don't know about it, never gave any attention |
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I know I should be aware but miss it many times |
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I do not know completely but I know when I am in very low or very high energy |
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Remarks :
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Are you aware of your Swara, ie the active nostril In breathing, and can you alter it? |
No I am not aware of the swara |
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I am aware, and able to alter it sometimes |
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I am aware but I am not able to alter it |
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Yes I am aware, am able to work on it most of the times |
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Remarks :
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Are you practising asana/ any other exercise/walk daily ? |
Never |
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Intermittently, not regular |
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Regular at least 3/4 days a week |
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Always, everyday |
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Remarks :
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Are you practising Pranayam everyday ? |
No, I have not learnt properly |
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Intermittently, not regular |
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Regular at least 3/4 days a week |
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Everyday once/twice for 15 min or more |
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Remarks :
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What is your average heart pulse ? |
less than 65 |
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65-80 |
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80-90 |
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more than 90 |
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Remarks :
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What is your number of breaths per minute ? |
less than 10 |
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10-15 |
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15-20 |
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more than 20 |
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Remarks :
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How do you rate yourself on the mental scale ? Patience/ Anxiety |
I am mostly patient |
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Sometimes I am anxious |
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I am anxious many times |
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Remarks :
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How do you rate yourself on the mental scale ? Trust/ Doubt |
I tend to trust myself, everything and everyone |
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I trust after evaluation, sometimes I doubt myself too |
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I have a low self worth, always doubt my abilities |
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Remarks :
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How do you rate yourself on the mental scale ? Peaceful / Disturbed |
I am mostly peaceful in all situations |
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In stressful situations I get disturbed |
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Nowadays mostly I am disturbed - under stress |
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Remarks :
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How do you rate yourself on the mental scale ? Fast / Slow |
I am a fast thinker |
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I am fast in thinking in some areas |
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I know I am slow in thinking |
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Remarks :
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On the following characteristic traits how do you rate yourself ? Simple / Complex |
I am known to be simple in my thinking and behaviour |
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In some relationships/situationsI am complex |
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People find me as a complex person |
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Remarks :
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On the following characteristic traits how do you rate yourself ? Humour |
I catch humor very fast |
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I like humor which is easy to understand |
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Many times I dont get the jokes |
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Remarks :
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On the following characteristic traits how do you rate yourself ? Creativity |
I generally try to find novel ways of doing everything |
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I am creative in my selected area |
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I generally follow the given norms |
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Remarks :
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Generally how do you find your state of mind on following parameters ? Happy / Sad |
I am generally happy in most situations |
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I am happy in selected situations with some people |
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I mostly tend to brood as I find myself filled with sadness |
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Remarks :
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Generally how do you find your state of mind on following parameters ? Balance |
I find myself balanced in most situations |
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There are some situations in which I lose my balance |
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I get agitated fast |
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Remarks :
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What is true about yourself from the following sentences - tick wherever most applicable |
In personal life, I have an ability to perceive risks about everything in life, and I take care of all the risks |
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I am a good trouble shooter, and generally I tend to solve problems any how when they arrive |
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While caring for myself and my family, I do care about others and help them whenever I can |
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I keep myself away from any trouble causing situation |
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I can sense opportunity and use it to provide to provide help to people around me |
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Everything is alright and all is going on as it should be |
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I am not bothered about security in life, because right things happen to me/ come to me at right time always |
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I keep the basic minimum for myself and family, and use the rest to provide for others |
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Remarks :
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What is true about yourself from the following sentences - tick wherever most applicable |
World is a place of fun, you should know how to enjoy |
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I dont see anything around me which I can enjoy, or inspire me, my appetite is low |
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I dont believe in hollow happiness, first I tackle the negative factors |
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I keep myself happy with good food, drink and things. There is no harm in indulging in things as long as it keeps me happy |
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I am generally happy from inside, so wherever I go generally things cheer up |
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For me it is important to make people around me happy, to be happy myself |
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People say I have charismatic personality, I generally see positive side of people |
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I have find myself in the state of bliss |
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Remarks :
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What is true about yourself from the following sentences - tick wherever most applicable |
I believe in doing things myself, and try hard to complete it, not get stuck by emotions |
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I generally dont see the need to do anything & don’t have energy or motivation to change things |
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I prefer to pick on small jobs, because I cant continue on same thing for long time |
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I work for good cause, for any person or organization, even if sometimes it may mean no reward |
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The larger power gets everything done with its infinite consciousness, I don’t have any role |
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I like to win, and I have the knack of winning over any opposition |
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I believe I am a serving instrument in whatever I am doing |
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I believe in doing things for a larger purpose with no attachment to rewards |
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Remarks :
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What is true about yourself from the following sentences - tick wherever most applicable |
I am good at making friends with anyone if I need to |
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I generally don't see the need to care for other's feelings, why should I ? |
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I can go all out for someone who loves me |
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I feel love for all, look for opportunities and think of ways to help them |
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I have few friends for whom I care as long as they follow the rules of our group / company/ orgn / etc |
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I have faith in the cosmic love and it flows through all beings |
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I love my family, friends & care for them |
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Usually I find wherever I go, whomever I am with, the anomisities dissolve and people find love |
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Remarks :
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What is true about yourself from the following sentences - tick wherever most applicable |
Assessment is fine, but there are too many questions, can you do something smaller ? |
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I am told that generally I dominate the conversations |
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I like to be alone, even if I am in crowd, I prefer to be by myself |
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I can connect easily wth people, and explain difficult things easily, with my words and my body language |
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What is there to talk, everybody else is doing the talking, I am a good listener |
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Even a word spoken by me is transmitted to the entire cosmos, so I care about what I speak |
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Words out smoothly when I speak, without efforts, and all seem to hear and agree to what I say |
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I can read minds of people while speaking so I care about what I speak |
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Remarks :
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What is true about yourself from the following sentences - tick wherever most applicable |
I am a normal human being who thinks about family and friends. I do my work to me best abilities |
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I am more interested in action rather than thinking, because somehow I cant think |
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I am good at selling, can sense opportunities and convince people |
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I am attracted to knowledge, and tend to use it constructively and ethically. I respect intelligence |
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I am scared to speak to intelligent people, so I pretend and act stupid, so that people don’t place too many demands on thinking |
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The understanding of the multidimensional consciousness and energy through which I understand all is difficult to be articulated here |
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I tend to think out of the box, creatively, and people around me are generally amazed at it |
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Often I have access to intuition and higher wisdom, which helps others |
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Remarks :
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What is your attitude towards FOOD ? |
I eat to enjoy food |
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Eating is my offering to the body |
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I eat to take care of my body needs |
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I eat so that my body serves me well |
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Remarks :
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What is your attitude towards Sleep rest ? |
I love to sleep and find opportunities to sleep whenever I can |
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I sleep enough to give necessary rest to my body |
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I sleep to get in touch with the higher self within me |
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I sleep as much as required so that I can work to me best capacity |
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Remarks :
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What is your attitude towards Work ? |
I work as it needs to be done |
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I work to earn |
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I work because I enjoy doing it |
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I work to liberate myself from bondage |
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Remarks :
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What is your attitude towards Recreation & Entertainment ? |
I seek realization by renouncing mortal pleasure and seek spiritual satisfaction |
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I involve myself in a hobby to keep my mind fresh |
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I look forward to pleasurable moments |
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I need a break from work routine so I entertain myself |
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Remarks :
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What is your attitude towards Exercise / Yoga ? |
I cant stay without Yoga/Exercise, I feel uncomfortable whenever I miss |
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Through Yoga I seek liberation from body mind attachment and move to higher goals |
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I do Yoga/Exercise because it is my responsibility to keep my body and mind in good health |
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My body is my instrument, so I have to keep it in good condition so that it gives best output |
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Remarks :
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What is your attitude towards Friends and Relations ? |
Friends and Relatives are my mirror for self development |
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I look forward to happy moments with friends and relatives |
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I always support my friends and relatives |
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I rely on Friends and Relatives when in trouble |
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Remarks :
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Follow Up Date (dd/mm/yyyy)
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Grand Total
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