Your Personalized Success Blocker Assessment

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First and Last Name* This field is required.Please introduce yourself!
First Name
Last Name
2
Email Address* This field is required.Where would you like me to send the final assessment report?
example@example.com
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1. LIMITING BELIEFS* This field is required.Do you tell yourself you're not worthy, too old. not good or educated enough or something similar?
Please select 1 of the 5 responses
Please select 1 of the 5 responses
Never - score: 1
Rarely - score: 2
Occasionally - score: 3
Frequently - score: 4
Always - score: 5
4
2. UNPRODUCTIVE HABITS* This field is required.Do you have poor sleep habits or indulge in activities that affect your health, relationships or productivity or other?
Please select 1 of the 5 responses
Please select 1 of the 5 responses
Never - score: 1
Rarely - score: 2
Occasionally - score: 3
Frequently - score: 4
Always - score: 5
5
3. SELF-DOUBT* This field is required.Do you lack confidence, question your ability or dislike yourself in some way?
Please select 1 of the 5 responses
Please select 1 of the 5 responses
Never - score: 1
Rarely - score: 2
Occasionally - score: 3
Frequently - score: 4
Always - score: 5
6
4. PROHIBITIVE MINDSET* This field is required.Do you think you can't change, learn a new skill or overcome a significant obstacle in your life?
Please select 1 of the 5 responses
Please select 1 of the 5 responses
Never - score: 1
Rarely - score: 2
Occasionally - score: 3
Frequently - score: 4
Always - score: 5
7
5. PROCRASTINATION* This field is required.Do you NOT do something you know you should, but not know why you behave that way?
Please select 1 of the 5 responses
Please select 1 of the 5 responses
Never - score: 1
Rarely - score: 2
Occasionally - score: 3
Frequently - score: 4
Always - score: 5
8
6. LOW PRODUCTIVITY* This field is required.Do you end your day and question what you've achieved, do you never seem to get much done?
Please select 1 of the 5 responses
Please select 1 of the 5 responses
Never - score: 1
Rarely - score: 2
Occasionally - score: 3
Frequently - score: 4
Always - score: 5
9
7. SELF-SABOTAGE* This field is required.Do you, consciously or subconsciously, think or behave in a way that interferes with your goals, well being or relationships?
Please select 1 of the 5 responses
Please select 1 of the 5 responses
Never - score: 1
Rarely - score: 2
Occasionally - score: 3
Frequently - score: 4
Always - score: 5
10
8. NEGATIVE SELF-TALK* This field is required.Do you talk to yourself unkindly or harshly or criticise or get angry with yourself a lot?
Please select 1 of the 5 responses
Please select 1 of the 5 responses
Never - score: 1
Rarely - score: 2
Occasionally - score: 3
Frequently - score: 4
Always - score: 5
11
9. POOR TIME MANAGEMENT AND PERFECTIONISM* This field is required.Do you miss deadlines and always seem to rush as there is never enough time? Do you waste time making things perfect because they never seem good enough or you think you can make them better?
Please select 1 of the 5 responses
Please select 1 of the 5 responses
Never - score: 1
Rarely - score: 2
Occasionally - score: 3
Frequently - score: 4
Always - score: 5
12
10. BAD ROUTINES* This field is required.Do you feel stressed and anxious, do you always feel tired, are your relationships strained?
Please select 1 of the 5 responses
Please select 1 of the 5 responses
Never - score: 1
Rarely - score: 2
Occasionally - score: 3
Frequently - score: 4
Always - score: 5
13
11. POOR GOAL SETTING* This field is required.Do you set goals but rarely achieve them, or make New Year's resolutions and forget them after 2 weeks?
Please select 1 of the 5 responses
Please select 1 of the 5 responses
Never - score: 1
Rarely - score: 2
Occasionally - score: 3
Frequently - score: 4
Always - score: 5
14
12. POOR FOCUS AND PRIORITIZING* This field is required.Do you get easily distracted, start things you don't finish, unconsciously duplicate tasks or just feel it's difficult to focus on work?
Please select 1 of the 5 responses
Please select 1 of the 5 responses
Never - score: 1
Rarely - score: 2
Occasionally - score: 3
Frequently - score: 4
Always - score: 5
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Total Score of Success Blockers 1 to 12
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How to Interpret your scoreScore Interpretation * If your score is 12 it means you are super-human and probably from another planet! * A score below 24 means you’re in amazing shape, pat yourself on the back! * A score 25–36 means you would benefit from some work on the Blockers with scores above 2. * A score 37–60 means you will enjoy life-changing results if you seek coaching to overcome your Blockers with a score of 3 or above. Please feel free to make a no obligation appointment with Garry if you would like to discuss your results with him, click here. Also don’t hesitate to come back in a few months to take the assessment again and see how any changes you have made have affected your score, click here To see what you can do to improve your score go here. I hope you found this quick assessment informative, if you would like to give me any feedback please email me at garry@garrygouldtransforms.com. Good luck becoming a better version of you! Please feel free to make a no obligation appointment with Garry if you would like to discuss your results with him, click here. Also don’t hesitate to come back in a few months to take the assessment again and see how any changes you have made have affected your score, click here To see what you can do to improve your score go here. I hope you found this quick assessment informative, if you would like to give me any feedback please email me at garry@garrygouldtransforms.com. Good luck becoming a better version of you!
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