Confidential Self Assessment Section 1 of 4
The purpose of this confidential survey is to get a clear picture of where you are, what you want to create from here forward, and an understanding of how best to support you.
Please take your time to fill out the survey and use it to generate self-awareness. However, if you feel overwhelmed, please give yourself 30 minutes to complete it and send what you have at that point.
Email address *
Name *
Your answer
Phone Number
Your answer
Well Being
Well Being- Physical Body
Low
High
Well Being- Emotional
Low
High
Well Being- Mental
Low
High
Well Being- Spiritual
Low
High
Career and Finances
Career Achievements
Low
High
Career Satisfaction
Low
High
Financial Freedom/Security
Low
High
Relationships
Family Relationships
Low
High
Friendships
Low
High
Romantic Relationship
Low
High
Environment
Environment- Home
Low
High
Environment- Work
Low
High
Life
Overall Satisfaction
Low
High
Service to Others
Low
High
Joy
Low
High
Guilt
1 Being No Experience of Guilt, 10 Being High Experience of Guilt
Low
High
Success
Low
High
Adventure
Low
High
Self Love
Low
High
Being Loved (By Others, World, Spirit)
Low
High
Love for Others
Low
High
Personal Growth
Low
High
Success
Low
High
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