RTT® — Initial Assessment RTT® DEEP WORK PROGRAMME Initial Assessment — Where Are You Now?Before we have the first call — take 15 minutes with this assessment. Answer honestly. There are no right answers. This is not a test. It is a mirror. Your scores from SECTION 5 here become your baseline. At the end of the programme, you will answer the same questions from SECTION 5 again. The difference between those two moments is your transformation — measured, visible, yours.SECTION 1 — PERSONAL DETAILSFirst NameLast NameAge0CountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)RomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwePhone/MobileRelationship status Single In a relationship Married Divorced Widowed It's complicatedEmployment status Employed full-time Employed part-time Self-employed Business owner Unemployed — seeking work Unemployed — not seeking work Student Retired OtherEmergency contact nameEmergency contact phoneEmergency contact — relationship to youSECTION 2 — HEALTH & SAFETYAre you currently under the care of a doctor, psychiatrist, or therapist? Yes NoIf yes — what are you being treated for, and are they aware you're doing this work? Are you currently taking any medication — prescribed or otherwise?Have you ever been diagnosed with any of the following? Depression Anxiety disorder PTSD Bipolar disorder Schizophrenia or psychosis Borderline personality disorder None of the above Prefer not to sayAre you currently experiencing suicidal thoughts or self-harm urges? No Yes — passive thoughts only (not acting on them) Yes — activelyHow would you describe your emotional stability right now? Stable — I have difficult moments but I'm generally functioning Somewhat unstable — I'm struggling more than usual Very unstable — I'm in crisisIs there anything else about your health or history that feels important for me to know? SECTION 3 — WHAT'S GOING ONBe as honest as you can here. The more specific you are, the more useful our work together will be.What is the main thing you want to work on?Where is this affecting your life most? Work Career Relationships Intimacy Confidence Self-worth Anxiety Stress Sleep Addictions (eating, smoking, alcohol, adult content, gambling, other) Anger or emotional reactions Feeling stuck or directionless Something from my past Health issues OtherHow long has this been going on? Less than a month 1–6 months 6 months–2 years 2–5 years As long as I can rememberHow is this affecting your daily life right now?What have you already tried? SECTION 4 — GOING DEEPERThese questions go further. Take your time with them — there's no need to have polished answers.When you think about this issue, what emotions come up most? Is there a repeating pattern you've noticed? What does the voice in your head say about this, at your lowest? Is there anything from your past — childhood, family, a specific event — that you feel may be connected to this? SECTION 5 — YOUR BASELINEThe mind and its relationship with itself.MENTAL PEACEThe mind and its relationship with itself.How would you rate your mental peace/ mental stability right now?0How often do you experience intrusive or repetitive thoughts? Almost constantly — my mind rarely quiets Most days — it's the background noise of my life Sometimes — particularly under stress Rarely — I generally feel mentally clearWhat does your mind do when you lie down at night?Which of these do you recognise? Tick all that apply: Difficulty switching off even when nothing urgent is happening Replaying conversations or decisions repeatedly A persistent low-level anxiety with no clear cause Needing something (phone, drink, screen) to quiet the mind Waking in the night with thoughts already running A voice that regularly tells you you're not enough None of the above OtherSTABILITYRelationships, finances, the ground beneath your feet.How stable do you feel in your life right now?0How would you describe your closest relationships right now? Deeply connected — I feel seen and I show up fully Functional — we get along but there's a distance I can't explain Strained — there's tension or conflict I haven't resolved Isolated — I don't have relationships I'd call closeWhere do you feel most unstable right now — and what does that instability actually feel like?Which of these do you recognise? Tick all that apply: Shutting down emotionally in difficult conversations Feeling financially anxious even when things are objectively okay Difficulty making decisions and trusting them Relationships that feel surface-level no matter how long you've known the person A recurring sense that the ground could shift at any moment None of the above OtherHEALTHThe body and what it's carrying. How would you rate your physical and energetic health right now?0How do you typically end your day? With something that genuinely restores me With something that numbs or distracts me I don't really have a pattern — it varies I push until I crashWhat does your body tell you that you usually ignore?Which of these do you recognise? Tick all that apply: Sleep that doesn't fully restore you Tension you've stopped noticing because it's always there Using food, alcohol, or other substances to manage your state Consuming endless content, social, adult Energy that runs out before the day does A body that feels older or more tired than it should Physical symptoms that don't have a clear medical explanation None of the above OtherTRUSTIn yourself, in others, in life. How much do you trust yourself right now?0When something good happens in your life — how do you typically respond internally? I allow myself to fully receive it and feel good I acknowledge it briefly then move on quickly I find a reason to discount it or wait for it to end I feel suspicious of it — like something will go wrongWhere does the voice that tells you you're not enough show up most?Which of these do you recognise? Tick all that apply: Needing external validation to feel okay about yourself Assuming people see you less favourably than they do Difficulty accepting compliments or positive feedback A persistent feeling that you need to earn your place Replaying interactions to check if you said the wrong thing Expecting things to go wrong when they're going well None of the above OtherPERSONAL DEVELOPMENTThe man you are becoming.How aligned is your current life with the man you want to become?0How would you describe your relationship with personal growth right now? Active — I am consciously working on myself Passive — I understand myself but struggle to change Stuck — I keep arriving at the same places Unclear — I don't have a strong sense of directionWhat is the gap between the man you are today and the man you want to become?What has stopped you from closing that gap so far?OVERALLOverall — how would you rate your life right now?0SECTION 6 — WHAT YOU WANTThe mind and its relationship with itself.How can this session help you the most?How will life be without this problem? What will be different about the way you will be behave and feel. What would freedom feel like? How ready are you to do your part — the recording, the actions, the honesty? 10 — Completely committed 7–9 — Very ready 4–6 — Fairly ready 1–3 — Still figuring it outSECTION 7 — PRACTICALThe mind and its relationship with itself.Have you experienced hypnotherapy or RTT® before? Yes NoIf yes — briefly, what was your experience?Will you have a private, quiet space for the session with no interruptions? Yes I'll need to arrange thisDo you have headphones and a stable internet connection? Yes I'll need to check thisSECTION 8 — CONSENTThe mind and its relationship with itself.I confirm my answers are honest. I understand this is not medical treatment YesI understand that RTT® does not replace professional medical or psychiatric care. YesI take responsibility for my own participation — including listening to my recording and completing my actions. YesI understand that results are not guaranteed and depend significantly on my engagement and honesty. YesI consent to our session being recorded for the purpose of creating my personalised audio recording. This recording will not be shared with anyone. YesI confirm I am emotionally stable enough to participate in this work at this time. YesI consent to Cristina Girleanu collecting and storing the personal data and health information provided in this form, for the purpose of delivering the session I have booked. I understand this includes sensitive health data and that it will be held securely and confidentially. I can withdraw consent at any time by contacting cristina@cristinagirleanu.com. YesSubmit my assessment