Initial Client Diagnostic Assessment
This diagnostic tool helps determine if our process is a fit for where you are right now. Please answer honestly; there are no wrong answers.
Hello,
Before we go any further, I want to be straight with you about what this is and what it isn't. I'm not a therapist. I'm not going to tell you what to do. I'm not going to hand you a list of affirmations and send you on your way. What I do is ask the questions most people are too afraid, or too unaware, to ask themselves, because I've already asked every one of them about my own life. I've been through the process, and I can show you how I did it. This assessment is a diagnostic tool. It exists to figure out whether what I offer is the right fit for where you are right now. Some people aren't ready for this level of inquiry. That's not a judgment, it's information. Answer honestly. This works when you do.
First Name
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Last Name
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Email Address
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
City / State / Country
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How did you find me?
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Instagram
Substack
X (Twitter)
Book
Referral
Other
Q1. In one or two sentences, what made you fill this out today, not last week, not last month, today? Be specific. 'Something felt off' is a start. What was the moment?
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Q2. How would you describe yourself in terms of where you are in life right now? (Choose all that apply)
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Successful on paper, empty on the inside
Running on autopilot and not sure when that started
Chronically tired despite doing 'all the right things'
People-pleasing at the cost of yourself
Know something needs to change but can't name what
Body giving you signals you've been ignoring
High-functioning but internally disconnected
In a pattern you've tried to break before (and haven't yet)
Q3. What's your current professional situation?
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Employed full-time
Self-employed / entrepreneur
In transition
Stay-at-home parent
Other
Industry / Role
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Q4. On a scale of 1–10, how willing are you right now to face real discomfort and not inspirational-quote discomfort, actual hard-truth discomfort..in order to get to the root of what's not working? 1 = Not at all ready | 10 = I'm done avoiding this — let's go
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Not at all ready
1
2
3
4
5
6
7
8
9
I'm done avoiding this — let's go
10
1 is Not at all ready, 10 is I'm done avoiding this — let's go
Q5. Have you tried to address what's been 'off' before? If yes, what did you try, and why do you think it didn't stick? Be specific. 'I tried therapy' or 'I read a lot of books'...and then what?
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Q6. What do you think is the primary reason you haven't made this change yet?
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I didn't know where to start
I started and stopped — I don't trust myself to follow through
I was waiting until things 'calmed down'
I've been trying surface fixes and hoping they'd be enough
I genuinely didn't know what the real problem was
Other
Q7. What's the cost: to your health, your relationships, your sense of self — if nothing changes in the next 12 months? Write it out. Don't soften this. Give me the real answer.
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Q8. Which of the following best describes what you're looking for in working with someone right now?
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A — Tell me what to do. Give me a clear plan and I'll execute it.
B — Ask me the hard questions. Help me figure out what I actually want and what's blocking me.
C — I'm not sure yet — I just know I need something different than what I've tried.
Q9. Be honest: are you looking for someone to confirm what you've already decided, or are you open to finding out that your diagnosis of your own problem might be incomplete? Neither answer disqualifies you. But I need to know.
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Honestly, I want confirmation
I'm genuinely open to being wrong about the root cause
Somewhere in between
Explain:
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Q10. How do you typically respond when someone challenges a belief you hold about yourself or your situation? There's no right answer here. I just need to know who I'm working with.
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Q11. What does 'real change' look like to you, not surface change, but the kind that sticks? If you've experienced this in any area of your life before, describe it. If not, describe what you imagine it feels like.
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Q12. Can you realistically commit 3–5 hours per week to honest self-inquiry, reflection, and assigned work during our engagement?
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Yes, and I'll protect that time
Probably, but it will be a stretch
Honestly, no — not right now
If 'probably' or 'no' — what would need to shift for that to change?
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Q13. Are you in a financial position to invest in this diagnostic process AND in the specialized referrals that follow based on what we discover?This isn't about a specific dollar amount, it's about readiness to invest in the full process, not just the first step.
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Yes
Not yet, but I'm working toward it
I'm not sure what this entails — can you tell me more?
Q14. On a scale of 1–10, how action-oriented are you when you get clarity on something? Meaning: when you know what needs to happen, do you actually do it? 1 = I tend to know what to do and still not do it | 10 = Clarity = action, every time
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I tend to know what to do and still not do it
1
2
3
4
5
6
7
8
9
Clarity = action, every time
10
1 is I tend to know what to do and still not do it, 10 is Clarity = action, every time
Tell me more — describe a recent example (it can be small):
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Q15. Which of these physical or behavioral signals do you consistently notice in yourself? (Check all that apply) Physical Signals
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Chronic fatigue — tired no matter how much you sleep
Persistent tension — jaw, neck, shoulders, chest
Shallow breathing — you realize you've been holding your breath
Digestive issues without a clear medical cause
Feeling 'wired and tired' at the same time
Numbing habits (alcohol, scrolling, food, busyness) that feel automatic
Mental & Emotional Signals
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Difficulty making even simple decisions
Brain fog — slower thinking, memory gaps, hard to focus
Emotional numbness — things that should bother you, don't. Things that should feel good, don't land.
Feeling like a 'spectator' in your own life — going through the motions
Anger or irritability that feels out of proportion — or that you suppress entirely
Anxiety that doesn't have a clear source — it's just 'on'
Behavioral Signals
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Staying constantly busy to avoid stillness (and what stillness might surface)
Saying yes when you mean no — compulsively, automatically
Social withdrawal — being around people feels performative or exhausting
Procrastinating on things you genuinely want to do
Hyper-vigilance — constantly monitoring others' moods and adjusting yourself accordingly
Starting things — projects, habits, relationships — and abandoning them before they can fail
Q16. How long have these signals been present?
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Less than 6 months
6 months – 2 years
2–5 years
Longer than I can remember
Q17. Which of these patterns feels most like you right now? (These are nervous system survival patterns, not flaws. Choose the one(s) you recognize most.)
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Fight — I get irritable, controlling, or aggressive when I feel threatened or overwhelmed
Flight — I stay relentlessly busy, start new things, or exit situations before they get too real
Freeze — I know what I need to do and I can't move. I stall, avoid, dissociate.
Functional Freeze — I'm performing well externally, but internally I feel hollow, numb, or robotic
Fawn — I shape-shift. I people-please. I abandon what I want to avoid conflict or abandonment.
Some combination of the above (describe below)
Describe what this looks like in your day-to-day life:
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SECTION 6 — Life Satisfaction Inventory Rate each area of your life on a scale of 1–10. 1 = This is where the leak is — it's draining everything else. 10 = Solid. This area is genuinely working. Be a fair witness to yourself. Don't inflate. Don't deflate. Just honest.
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Rows
1
2
3
4
5
6
7
8
9
10
Physical health & energy
Mental clarity & focus
Emotional well-being (day-to-day)
Primary romantic relationship / intimacy
Family relationships
Friendships & social connection
Career / professional purpose
Financial stability & trajectory
Spiritual connection / sense of meaning
Personal identity — knowing who you are
Body trust & physical safety in your own skin
Boundaries — being able to say no without guilt
Body trust
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Physical health
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Emotional wellbeing
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Career and professional purpose
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Spiritual connection
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Q18. Which area had the lowest score? What do you think is driving that?
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Q19. Which area, if improved, do you believe would have the biggest positive ripple effect on everything else? Not the one you think you 'should' fix — the one that would actually unlock the most.
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Q20. Is there an area you rated high that is actually masking something you don't want to look at? If so, name it. This one's for the honest among us.
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Q21. If you had to name the single biggest pain point in your life right now — not the symptom, but what you think is actually causing it...what would it be? Take your time with this. If you have multiple, list them, but then put a star next to the one that feels most urgent.
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Q22. How long have you been living with this pain point?
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Less than a year
1–3 years
3–5 years
Most of my adult life
I don't know — it's always been there
Q23. What have you told yourself is the reason this hasn't changed yet? Write the actual story you tell yourself, not the polished version.
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Q24. What do you think is actually in the way? (This may be different from Q23.) If you can name it: a belief, a habit, a relationship pattern, a fear, a decision you've been avoiding, do it here.
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Q25. If this pain point were completely resolved, if it was gone and you had truly moved through it, what would your life look and feel like? Be specific. Not 'I'd be happier.' What would a Tuesday look like?
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Q26. What is the biggest risk, in your mind, of actually making this change? What are you afraid you'd lose, have to face, or become if this actually worked?
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Q27. What areas of your life are you hoping to create change in? (Check all that apply and prioritize — enter a 1 next to the most urgent, 2 next, etc.)
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Physical health, energy, and how I feel in my body
Nervous system regulation — getting out of survival mode
Mental clarity and emotional bandwidth
Career direction / professional alignment
Relationship patterns (romantic, family, friendships)
Financial situation and relationship with money
Spiritual connection / sense of meaning and purpose
Identity — knowing who I am and actually living as her/him
Boundaries and my own sense of self-worth
Processing childhood or adult experiences that are still running the show
Q28. What does success look like to you at the end of our work together? What specific, tangible thing would tell you this was worth it?
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Q29. What's something you want that you haven't allowed yourself to say out loud yet...to yourself or anyone else? This is the one that usually holds the most information.
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Q30. Is there anything about your background, history, or current situation that you think is important for me to know that didn't fit neatly into the questions above? You don't have to share anything you're not ready to share. But if there's something relevant, this is the place.
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Q31. What's the one question you're most afraid I'm going to ask you? You don't have to answer it here. Just name it.
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Q32. Complete this sentence: 'The thing I most need someone to help me see clearly right now is...'
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Q33. Have you read my book, 'My Father, Jeffrey Epstein,' or engaged with my content on Instagram (@analeakaleo), Substack, or X before filling this out?)
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Yes — book
Yes — Instagram
Yes — Substack
Yes — X
No — I found you through a referral or search
Anything that landed for you or made you decide to reach out?
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Q34. On a scale of 1–10, how ready are you, right now, today, to stop treating the symptoms and get to the actual root?1 = I'm still in the 'maybe someday' phase | 10 = I'm done waiting. Let's go.
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I'm still in the 'maybe someday' phase
1
2
3
4
5
6
7
8
9
I'm done waiting. Let's go.
10
1 is I'm still in the 'maybe someday' phase, 10 is I'm done waiting. Let's go.
Before I say Goodbye..
I review every assessment personally. You'll hear from me within 3–5 business days. If this is a fit, I'll reach out to schedule a diagnostic conversation, not a sales call, an actual conversation where we start the real work of figuring out what's actually going on. If the timing isn't right, or if what you need is something different than what I offer, I'll tell you that directly and point you toward what I actually think would serve you better. That's what this process is about: real answers, not a transaction. I've been through the process. I can show you how I did it. The rest is up to you. Aloha and Mahalo, Analea Kaleo
FOR PRACTITIONER USE ONLY — Readiness Category (auto-calculated)
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FOR PRACTITIONER USE ONLY - High-Priority Signals
Next Step
No further action
Schedule diagnostic call
Refer to specialist
Send resources
Follow-up in 2 weeks
Other
High-Priority Flag
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