Readiness & Stability Screening
3 Minutes | Readiness & Stability Screening
Basic Demographics
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
SECTION 1 — Capacity Snapshot
Energy level (1–10)
*
Clarity level (1–10)
*
Emotional stability (1–10)
*
SECTION 2 — Functional Integrity
Are you currently able to fulfill your professional responsibilities?
*
Yes
No
Are you currently able to make decisions without panic or urgency?
*
Yes
No
Are you currently sleeping at least 6 hours most nights?
*
Yes
No
SECTION 3 — Current State
What feels most unsustainable right now?
*
SECTION 4 — Crisis Screening
Have you experienced any of the following in the last 90 days:
*
Yes
No
(Select Yes if you have experienced any of the following: Panic attacks, Emotional breakdown requiring intervention, Major depressive episode, Impulsive resignation or drastic decision, Medical leave for stress.)
If yes, briefly explain.
*
SECTION 5 — Expectation Check
What do you believe this advisory will provide that you cannot create alone?
*
Which level best describes the change you are seeking?*
Tactical improvement
Strategic refinement
Structural authority expansion
Identity-level authority recalibration
SECTION 6 — Commitment Readiness
Are you willing to implement small but consistent behavioral changes weekly — even when inconvenient?
*
Yes
No
Are you prepared for a premium-level financial investment and disciplined engagement process?*
Yes
No
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