Men reaching out for help + to grow...
This survey is private and will stay that way.

I appreciate you taking a few minutes and sharing where you are at and what you are seeking - in terms of growth.  

Sign in to Google to save your progress. Learn more
Name *
Email, please *
I'm here to focus on growing my RELATIONSHIP(s) with...  (click all that apply) *
Required
My biggest HOPES and WISHES for the relationship(s) that matter to me are... *
I suspect I may be SABOTAGING my relationships by...   *
NOPE
Maybe the culprit!
YUP, I gotta deal with that!
AVOIDING intimacy and conflict
Trying too hard to PLEASE everyone
Losing my TEMPER and hurting or scaring others
Being held back by FEARS and ANXIETIES
Not knowing how to create HEALTHY BOUNDARIES
ISOLATING myself and not reaching out
Trying to FIX others and/or myself
Feeling like a VICTIM and blaming...
Being too CRITICAL and JUDGY
COLLAPSING out of a lack of CONFIDENCE
The SKILLS, STRENGTHS and RESOURCES I have that may be helpful with evolving my relationship(s) are...   *
What else could be HELPFUL to me at this time is... *
NO need
Maybe
DEFINITELY would HELP!
Relationship MENTORING (1-1)
UNDERSTANDING them - their needs and reactions better.
LEARNING missing relationship SKILLS -- conflict resolution & repairing
HEALING my own deeper issues.
Growing the MUSCLES to be more EMOTIONALLY GENEROUS
Focusing more on my own HEALTH and HAPPINESS
Being WILLING to give them what they most need from me
Cultivating healthier micro HABITS
Being supported to stay ACCOUNTABLE to my goals
Help to resolve complex dilemmas WISELY
Having a COMMUNITY of men to support me to grow and bring my whole self to my relationships.
The level of PRIORITY for me now to take action to evolve myself and invest in my relationship(s) is... *
Not now.
I would do ANYTHING to make it better!
What I am able and willing contribute towards dedicated support for my growth right now? *
Required
THANKS for your honesty and courage filling this out. We'll get back to you soon. Until then, we wish you to know that you do not have to carry on alone. It takes a village to raise a healthy & whole man and to help our relationships to grow and thrive.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Powerful And Loving (PAL). Report Abuse
Google Forms