Client Questionnaire
Thank you for taking the time to fill out this questionnaire, it really helps me to develop and provide a better service.
Gender
Age
Relationship status
Do you have any children?
How many hours per week do you work on average?
Current personal annual income
What are your hobbies/where do you like to hang out?
Your answer
What challenges/worries/problems are you facing in your life right now which you would like to solve?
Your answer
If I could wave a magic wand over your wellbeing what would you like to change and why?
Your answer
What would it mean to you?
Your answer
What obstacles and struggles do you regularly come up against when trying to do this on your own?
Your answer
How motivated on a scale of 1-10 are you to do something about this right now?
Your answer
What changes/results would you like to achieve in the next 30 days, 3 months and 6 months?
Your answer
Any other comments
Your answer
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