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Intake Assessment

Kick off your coaching program with this intake assessment

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Intake Assessment

This intake assessment highlights areas most known psychologically to impact high performance.  My coaching experience, program and philosophy is based on the premise that understanding one's emotional intelligence and assessing a client's current state at the start of the program, gives us the ability to accelerate actions and utilize mindset reprogramming for rapid transformation and successful results. 

Question 2 of 25

Your Name

Question 3 of 25

How often do you experience lack of purpose?

A

Never

B

Rarely

C

Often

D

Always

Question 4 of 25

Lack of motivation?

A

Never

B

Rarely

C

Often

D

Always

Question 5 of 25

Lack of energy or enthusiasm?

A

Never

B

Rarely

C

Often

D

Always

Question 6 of 25

Lack of self-discipline?

A

Never

B

Rarely

C

Often

D

Always

Question 7 of 25

Lack of healthy habits (overeating, little-to-no exercise)?

A

Never

B

Rarely

C

Often

D

Never

Question 8 of 25

Addictions?

A

Never

B

Rarely

C

Often

D

Always

Question 9 of 25

Procrastination or lack of persistence/inability to recover?

A

Never

B

Rarely

C

Often

D

Always

Question 10 of 25

Negativity or depression?

A

Never

B

Rarely

C

Often

D

Always

Question 11 of 25

Wanting something for nothing or “gambler's mentality”?

A

Never

B

Rarely

C

Often

D

Always

Question 12 of 25

Indecision or over-caution?

A

Never

B

Rarely

C

Often

D

Always

Question 13 of 25

Fear of poverty?

A

Never

B

Rarely

C

Often

D

Always

Question 14 of 25

Fear of criticism?

A

Never

B

Rarely

C

Often

D

Always

Question 15 of 25

Fear of ill health? Old age? Death?

A

Never

B

Rarely

C

Often

D

Always

Question 16 of 25

Inability to make money or budget wisely?

A

Never

B

Rarely

C

Often

D

Always

Question 17 of 25

Other childhood trauma?

A

Never

B

Rarely

C

Often

D

Always

Question 18 of 25

Unhappy in personal life/relationships/unharmonious marriage?

A

Never

B

Rarely

C

Often

D

Always

Question 19 of 25

Unhappy in work situation or career choice?

A

Never

B

Rarely

C

Often

D

Always

Question 20 of 25

Holding on to negative past experiences or mistakes? processing of childhood trauma?

A

Never

B

Rarely

C

Often

D

Always

Question 21 of 25

Other known self-sabotage?

A

Never

B

Rarely

C

Often

D

Always

Question 22 of 25

Clarity of goals?

A

Never

B

Rarely

C

Often

D

Always

Question 23 of 25

How would you rate yourself on your ability to manage time effectively? What methods do you use? 

Question 24 of 25

Magic wand: If I could grant you one wish, what would it be?

Question 25 of 25

What else should I know?

Confirm and Submit