Pre-Consultation Questionnaire.
Please complete this form at least 24 hours before your appointment. Victims of Narcissistic abuse Coaching Services. If you wish to skip certain questions you don't wish to answer, please feel free to do so.
Email address *
What best describes your relationship dynamic?
What is your level of education?
Are you employed?
Do you feel like you've accomplished most goals you created for yourself?
What do you want to accomplish in your consultation(s)?
Your answer
Did you witness domestic abuse as a child?
Did you come from a single parent home?
Do you believe one or both of your parents may be a narcissist?
If so, briefly explain your relationship with the narcissistic parent?
Your answer
Have you previously received professional counseling?
Rate your self-esteem on a scale of 1-10 with 1 being the lowest *
Your answer
Do you keep the promises you make to yourself?
Are you satisfied with your health and body image? *
Do you trust your intuition?
Do you believe you are an empath?
Are you afraid of being abandoned?
Are you currently still in a relationship with a narcissist?
Do you have a pattern of starting relationships with narcissistic men/women?
Do you feel like you let yourself down a lot?
Has your narcissist ever hit you?
Is your narcissistic pattern verbally abusive?
Do you have children with your narcissistic partner?
Are you financially dependent on your narcissistic partner?
Do you have an on again off again relationship with the narcissist?
A copy of your responses will be emailed to the address you provided.
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