ISEE Group Thriving Family Challenge
Intake Questionnaire
Welcome to the, "Thriving Family Challenge". Please complete the questionnaire below. The information provided will be part of the process to assist us in assessing if we are a good fit to support your goals.
Thank you in advance for your interest in connecting with our company. The mission of ISEE Group, LLC is to "Restore the vision for vibrant relationships, thriving families and stronger communities". We look forward to journeying with you and your family through this experience.
If there was ONE BIG CHANGE that you wanted to make in your family life, what would it be? What is the biggest challenge, frustration or problem that's getting in the way of making that change? (please be as specific as possible)
Date
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Month
-
Day
Year
Date
Team Lead #1 - Name
*
First Name
Last Name
Team Lead #2 - Name
*
First Name
Last Name
Team Lead #1 Email
*
example@example.com
Team Lead #2 Email
*
example@example.com
Phone Number # 1
Phone Number # 2
How many members in your family are participating in the challenge?
List the members of your family that will participate in this challenge
Name, Age, gender
Give yourself a score in these 5 areas
1
2
3
4
5
6
7
8
9
10
Clarity - I feel that my family is clear about who we are, our purpose, and the direction we want to go in life
Physical Body
1
2
3
4
5
6
7
8
9
10
Biology - we have enough mental and physical energy needed to accomplish everything we set out to accomplish on a consistent basis
Leadership
1
2
3
4
5
6
7
8
9
10
Leadership - As a family we step up for ourself and others in uncomfortable situations and hold each other accountable
Efficiency
1
2
3
4
5
6
7
8
9
10
Efficiency - As a family we are efficient, consistently focused and good at minimizing distractions and maintaining priorities.
Mindset
1
2
3
4
5
6
7
8
9
10
Mindset - I feel that we are in a good place mentally (my self-talk, self-perception)
Are there any areas you want to elaborate on or provide additional information?
A deeper peek into your family dynamics...
Are there any employment or career challenges currently in your family? What do you do for a living, and why did you choose that path?
What are your top 3 goals that you are committed to accomplishing as a family right now?
What major stressors or challenges are getting in the way of your family right now?
When do you feel that your family is successful and content, what makes them feel that way?
What would your ideal family life look like if you could make it happen immediately?
What has prevented your family from having that ideal life?
What goals or dreams have you had for your family that you have given up on or failed at, and what do you believe caused you to stop or fail?
What failures have your family experienced in the past that you failed to learn from?
Evaluate yourself in these areas
1
2
3
4
5
6
7
8
9
10
My relationships - I'm in a fulfilling relationship or ready to be in one
Health
1
2
3
4
5
6
7
8
9
10
My overall health - I sleep well, manage stress effectively, eat well, exercise and take care of my physical environment
Lifestyle
1
2
3
4
5
6
7
8
9
10
Family hobbies - you have activities outside of work and school that challenges or brings you joy
Loved ones
1
2
3
4
5
6
7
8
9
10
Family and friends - we keep developing deep and loving relationships with people close to us
Money
1
2
3
4
5
6
7
8
9
10
Finances - As a family are you ahead of where you expected to be financially at this point in life
Mission
1
2
3
4
5
6
7
8
9
10
Are your family
Mission and purpose - clearly establish? Are family members clear about their role in this world?
Values/Standards/Expectations
1
2
3
4
5
6
7
8
9
10
Are there your family
values, standards & expectation clearly establish?
Spirituality
1
2
3
4
5
6
7
8
9
10
As a family - we have a spiritual/meditative practice and keep deepening it on a regular basis
What would happen if your family remain where you are currently?
How quickly would you want to change it?
The Investment & Commitment
How much time are you and your family members willing to invest daily, weekly, etc. to achieve the goals of the challenge?
How much would you be willing to invest in the family to optimize every area of your life and achieve your dream life?
$150-$300
$500-$1000
$1,500-2,000
Sponsorship/Scholarship Option
Other
Is there anyone else involved in you making this decision (If so, I recommend having a conversation prior signing up to participate)
No, just me
Yes, but I will have a conversation prior to confirm collective commitment to participate
Other
Please provide any additional information to assist us in determining your family selection to participate in the challenge
Submit
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