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Intake questionnaire

Ten questions, three types, ten minutes for the client. The open questions start them thinking before the first session; the scales give you a baseline to come back to at the end.

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Intake questionnaire

Thank you for booking. These questions take about ten minutes and help me prepare for our first session. Answer as much or as little as you like; the ones marked required are the three I cannot start without.

What would make the next six months a success? (required)Your answer
What is the one thing you most want to change? (required)Your answer
Where are you in that right now? (required)
  • Just thinking about it
  • Actively working on it
  • Stuck
  • Nearly there
What have you already tried?Your answer
How confident do you feel about this today? (required)
12345678910
Not at allVery
How much of your week feels reactive rather than chosen?
12345678910
Very littleMost of it
What gets in the way most often?Your answer
How do you like to be held to account?
  • Gentle nudges
  • Direct reminders
  • Let me come to you
Is there anything about how you work best that I should know?Your answer
Anything else before we start?Your answer

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