You can always press Enter⏎ to continue
Welcome to the Reality Assessment (v2)
Please fill out and submit this form. Then you will receive an email with a copy of this form, as well as your Reality Assessment Report.
12
Questions
START
1
Name
*
This field is required.
Previous
Next
Submit
Press
Enter
2
Email Address
*
This field is required.
example@example.com
Previous
Next
Submit
Press
Enter
3
Category
Please select one of the nine choices below
Please Select
Personal Life
Family
Career
Health and Wellness
Relationships and Connections
Personal Finances
Business
Operational (business)
General Reality Calibration
Please Select
Personal Life
Family
Career
Health and Wellness
Relationships and Connections
Personal Finances
Business
Operational (business)
General Reality Calibration
Previous
Next
Submit
Press
Enter
4
1. What problem or frustration keeps showing up that you wish would stop?
*
This field is required.
Previous
Next
Submit
Press
Enter
5
2. What usually happens right before this problem appears?
*
This field is required.
Previous
Next
Submit
Press
Enter
6
3. What person, habit, responsibility, situation, or belief seems to contribute to it most often?
*
This field is required.
Previous
Next
Submit
Press
Enter
7
4. What have you already tried to improve this situation, and what happened?
*
This field is required.
Previous
Next
Submit
Press
Enter
8
5. Why do you think this problem keeps happening?
*
This field is required.
Previous
Next
Submit
Press
Enter
9
6. What facts or observations make you question your own explanation?
*
This field is required.
Previous
Next
Submit
Press
Enter
10
7. If nothing changed over the next 12 months, what would likely happen?
*
This field is required.
Previous
Next
Submit
Press
Enter
11
8. What would a successful resolution look like in simple, observable terms?
*
This field is required.
Previous
Next
Submit
Press
Enter
12
9. Walk me through a typical weekday. Where does most of your time and energy actually go?
*
This field is required.
Previous
Next
Submit
Press
Enter
13
10. Looking across your life — not just right now — what themes, interests, values, or problems do you repeatedly return to regardless of circumstances?
*
This field is required.
Previous
Next
Submit
Press
Enter
14
9. Who is usually involved, and when or where does this problem most often occur?
*
This field is required.
Previous
Next
Submit
Press
Enter
15
10. Are there any unspoken rules, family expectations, or inherited patterns that may be contributing to this situation?
*
This field is required.
Previous
Next
Submit
Press
Enter
16
9. What parts of your work do you feel most energized by, and what drains you fastest?
*
This field is required.
Previous
Next
Submit
Press
Enter
17
10. Looking across every job or role you have had — what skills, problems, or types of work do you repeatedly return to regardless of the environment?
*
This field is required.
Previous
Next
Submit
Press
Enter
18
9. What specific measurement, outcome, or physical change would tell you this situation has actually improved?
*
This field is required.
Previous
Next
Submit
Press
Enter
19
10. What environment, time of day, or emotional state most consistently triggers the behavior you want to change?
*
This field is required.
Previous
Next
Submit
Press
Enter
20
9. What do you believe the other person or people involved would say about this situation if asked directly?
*
This field is required.
Previous
Next
Submit
Press
Enter
21
10. Is there a pattern in your relationships — across different people, roles, or seasons of life — that keeps repeating regardless of who is involved?
*
This field is required.
Previous
Next
Submit
Press
Enter
22
9. Briefly describe your current financial situation — income, primary expenses, debt, and savings. Include what you feel is most relevant.
*
This field is required.
Previous
Next
Submit
Press
Enter
23
10. What typically happens when you receive money — whether income, a bonus, or a windfall?
*
This field is required.
Previous
Next
Submit
Press
Enter
24
9. What part of the business creates the most value for customers, and what part consumes the most time, energy, or money relative to the value it produces?
*
This field is required.
Previous
Next
Submit
Press
Enter
25
10. What major decision, change, or opportunity have you been delaying — and what is the stated reason for the delay?
*
This field is required.
Previous
Next
Submit
Press
Enter
26
9. Walk me through the step-by-step process of how work moves through your operation from start to finished output. Where does it slow down, pile up, or get stuck most often?
*
This field is required.
Previous
Next
Submit
Press
Enter
27
10. Who owns the decision at the point where the problem most often occurs — and what happens when that decision needs to be made?
*
This field is required.
Previous
Next
Submit
Press
Enter
28
9. Looking across your life—not just the current situation—what themes, frustrations, values, or patterns do you repeatedly return to regardless of job, relationship, or circumstance?
*
This field is required.
Previous
Next
Submit
Press
Enter
29
10. What would be noticeably different in your daily life if this problem were resolved?
*
This field is required.
Previous
Next
Submit
Press
Enter
30
This assessment provides informational insights and does not constitute professional advice.
*
This field is required.
The quality of the assessment is dependent on the quality and completeness of the information provided. This report is outside of what may require specialized medical, mental health, legal, financial, or professional guidance.
I understand
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
30
See All
Go Back
Submit