Cycle-Breaker Clarity Call Application

Cycle-Breaking Roadmap & Baseline Assessment

This assessment is required after purchase and must be completed before course materials are manually delivered and before Call #1 is scheduled.Your responses will be used to create your personalized Cycle-Breaking Roadmap Summary and establish your baseline measurements for program effectiveness tracking.This assessment is reviewed personally by Eight Eighty-Eight Coaching. You will not receive automatic results.Participation in the case study component of this program is part of the discounted enrollment agreement.
Applicant Information
Full Name

First NameMiddle NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Age Range
Current Challenge and Context
What prompted you to book this session right now?
What area of your life feels most challenging at this moment?

Other
What recurring pattern, behavior, or situation would you like to change?
How long have you been dealing with this challenge?
Which statement best describes you right now?
Baseline Assessment
Rate each statement from 1 to 10 based on where you are right now. 1 = Strongly Disagree and 10 = Strongly Agree. These responses help establish your starting point and will be reviewed by your coach.
I can accurately identify what I am feeling.

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1 is Strongly Disagree, 10 is Strongly Agree
I understand what triggers my emotional reactions.

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1 is Strongly Disagree, 10 is Strongly Agree
I recognize emotional patterns in my life.

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1 is Strongly Disagree, 10 is Strongly Agree
I understand how my childhood, family, or past experiences influence my current behavior.

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1 is Strongly Disagree, 10 is Strongly Agree
I feel safe expressing my emotions.

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1 is Strongly Disagree, 10 is Strongly Agree
I communicate my needs clearly.

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1 is Strongly Disagree, 10 is Strongly Agree
I often suppress my feelings.

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1 is Strongly Disagree, 10 is Strongly Agree
I can discuss difficult emotions honestly.

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1 is Strongly Disagree, 10 is Strongly Agree
I can calm myself when I feel emotionally triggered.

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1 is Strongly Disagree, 10 is Strongly Agree
My emotions often control my behavior.

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1 is Strongly Disagree, 10 is Strongly Agree
I recover well after emotional setbacks.

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1 is Strongly Disagree, 10 is Strongly Agree
I feel emotionally steady most days.

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1 is Strongly Disagree, 10 is Strongly Agree
I set healthy boundaries.

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1 is Strongly Disagree, 10 is Strongly Agree
I struggle to say no.

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1 is Strongly Disagree, 10 is Strongly Agree
I trust myself when making relationship decisions.

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1 is Strongly Disagree, 10 is Strongly Agree
I recognize unhealthy relationship patterns.

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1 is Strongly Disagree, 10 is Strongly Agree
I understand the cycles I am trying to break.

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1 is Strongly Disagree, 10 is Strongly Agree
I actively challenge unhealthy family, relationship, or survival patterns.

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1 is Strongly Disagree, 10 is Strongly Agree
I feel capable of creating a different future.

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1 is Strongly Disagree, 10 is Strongly Agree
I believe lasting change is possible for me.

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1 is Strongly Disagree, 10 is Strongly Agree
Growth Areas and Support Needs
Which of these topics resonates most with your current journey?
What do you believe is holding you back most right now?
What would success look like for you six months from now?
How committed are you to making changes in your life right now?

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1 is Not committed, 10 is Fully committed
What kind of support are you looking for?
If nothing changes over the next year, what worries you most?
Is there anything else you would like me to know before our session?
Cohort Name
Participant ID
Program Version
Reflection & Future Vision
What cycle are you most committed to breaking?
What do you hope changes by the end of this course?
What would help you feel emotionally supported during this process?
If this course worked exactly how you needed it to, what would be different 90 days from now?
What do you want me to understand about your healing journey before reviewing your roadmap?
Consent & Participation Agreement
Please review and agree to the following before submitting your assessment. This information helps ensure clarity regarding the purpose of this program, your participation responsibilities, and the use of assessment data for program evaluation and improvement.
Program Understanding & Participation Agreement
Discounted Enrollment Acknowledgment
May your responses be used in a de-identified case study, program evaluation, or effectiveness report?
If selected, may we contact you about providing a written or video testimonial?
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Cycle-Breaking Roadmap & Baseline Assessment

Applicant Information

Current Challenge and Context

Baseline Assessment

Growth Areas and Support Needs

Reflection & Future Vision

Consent & Participation Agreement