#2
Status assessment

This questionnaire is designed as an assessment of your current status.

Instructions

Try to be honest and connect with a personal part of yourself. Be as descriptive as possible. There are no right or wrong answers.

First name

Last name

How would you describe your current life satisfaction?

In what area are you experiencing the most problems?

Describe the greatest detrimental symptoms you are experiencing.

Physical or psychological reactions that are unwanted and contribute to having a negative experience

What is the primary goal you would like to get help with?

How close do you feel to your maximum potential?

How confident are you that you can change your current status into a more positive direction?

How often do you exercise?

Gym or classes

How active are you on a daily basis?

Moving in general (i.e. not being in front of a desk or sitting)

How much effort are you willing to invest in changing your life course?