Bad Karma Coaching Veteran and First Responder Baseline Climate Survey
Welcome to your personal assessment. Think of this as a snapshot of where you are right now—a chance to reflect on your life as a whole, the foundation and strengths you’ve built, and where extra support might serve you best. Use your collective life experience to answer honestly. This is designed entirely for your own insight and self-reflection, so feel free to skip optional questions or mark “Prefer not to say” whenever you choose.
Section A — Contact Information
Full name
*
First Name
Middle Name
Last Name
Preferred name
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email address
*
example@example.com
Preferred contact method
Phone
Text message
Email
Section B — Military and First Responder Background
Which description best reflects your background?
*
Military veteran
Active-duty military
Reserve or National Guard
Retired military
First responder
Retired first responder
Both military and first responder
None of the above
Are you a military veteran or current/retired service member?
*
Yes
No
Prefer not to say
Current or most recent military status
Please Select
Active duty
Reserve/National Guard
Veteran—separated
Retired
Medically retired
Other
Prefer not to say
Not applicable
Military branches served
Army
Marine Corps
Navy
Air Force
Space Force
Coast Guard
National Guard
Other
Prefer not to say
Total years of military service
Less than 1
1–4
5–9
10–14
15–19
20+
Prefer not to say
Are you currently employed or serving as a first responder?
*
Yes, currently
Previously/retired
No
Prefer not to say
First responder employment/service status
Please Select
Active/current
Retired
Former
Volunteer
Other
Prefer not to say
Which type of first responder best describes your primary or most recent service?
*
Police / law enforcement
Fire service
EMS / paramedic
Emergency room / trauma care
Other (please specify)
Prefer not to say
Total years of first responder service
Less than 1
1–4
5–9
10–14
15–19
20+
Prefer not to say
Current or most recent role/title
Section C — Marriage, Family, and Divorce History
Current relationship status
*
Married
In a committed partnership
Separated
Divorced
Widowed
Single
Prefer not to say
How long have you been together? (years)
Number of biological or adopted children
*
Number of step-children
*
Have you ever been divorced?
*
Yes
No
Prefer not to say
Number of divorces
Looking back, what do you feel was the single most contributing factor to your divorce or divorces?
Infidelity
Emotional distance or disconnection
Incompatibility / different values or life goals
Finances or financial stress
Children or parenting-related conflict
Lack of communication
Other (please specify)
Prefer not to say
Is there anything else about your family context that would help support you?
Section D — Participant Self-Assessment
Pillar 1 — Disconnection and Isolation
*
Rows
1
2
3
4
5
6
7
8
9
10
Peer and Brotherhood Connection: How connected and understood do you feel by friends, battle buddies, or colleagues outside of work shifts? (1 = Completely isolated / Only One mindset; 10 = Strong, trusted support circle)
Emotional Openness: How comfortable and capable are you when sharing what is truly on your mind with people you trust? (1 = Complete fortress / completely closed off; 10 = Transparent and direct)
Transitioning Out of Operational Mindset: How easily can you take off the uniform or mental armor and step down from high-vigilance mode when off duty or retired? (1 = Always on tactical alert; 10 = Able to fully decompress)
Community Belonging: How engaged and aligned do you feel with purpose and community outside of tactical or high-stress environments? (1 = Totally detached / drifting; 10 = Highly grounded and purposeful)
Pillar 2 — Sleep and Nervous System Recovery
*
Rows
1
2
3
4
5
6
7
8
9
10
Sleep Quality and Restfulness: How consistently do you achieve deep, restorative sleep without frequent awakenings or nightmares? (1 = Broken, non-restorative sleep; 10 = Deep, uninterrupted recovery)
Sleep Onset: How effectively can your mind and body turn the switch off to fall asleep without reliance on substances or endless scrolling? (1 = Racing thoughts / hours to fall asleep; 10 = Falls asleep quickly and peacefully)
Morning Energy Baseline: How energized and clear-headed do you feel upon waking? (1 = Exhausted / running on stimulants; 10 = High natural vitality)
Physiological Recovery: How well does your nervous system recover from physical training, stress, or shift work? (1 = Chronic systemic fatigue / joint and muscle burn; 10 = Fast, resilient bounce-back)
Pillar 3 — Irritability and Emotional Regulation
*
Rows
1
2
3
4
5
6
7
8
9
10
Patience and Fuse Length: How well do you manage minor annoyances, noise, or family friction without snapping or reacting defensively? (1 = Hair-trigger fuse / frequent outbursts; 10 = Long fuse, calm response)
Stress Recovery Speed: When triggered, angered, or overwhelmed, how quickly can you regulate your breathing and return to a calm baseline? (1 = Stewing or agitated for hours or days; 10 = Resets within minutes)
Constructive Conflict Resolution: How constructively do you handle disagreements at home without shutting down or escalating? (1 = Immediate shutdown or escalation; 10 = Productive, calm dialogue)
Coping Mechanisms: How healthy and constructive are your stress-relief habits? (1 = Heavily reliant on unhealthy vices; 10 = Consistently constructive, healthy practices)
Pillar 4 — Presence and Family Connection
*
Rows
1
2
3
4
5
6
7
8
9
10
Active Family Presence: When spending time with your spouse and children, how mentally and emotionally focused are you in the room? (1 = Mentally miles away / distracted; 10 = Fully engaged and in the moment)
Affection and Warmth: How easily and naturally can you express warmth, tenderness, and verbal or physical affection to your partner? (1 = Cold / emotionally detached; 10 = Warm, loving, and reassuring)
Attentive Listening: How well can you listen to family concerns without immediately jumping into fix-it, tactical analysis, or defensive interrogation mode? (1 = Highly reactive or dismissive; 10 = Empathetic, active listener)
Shared Joy and Playfulness: How often do you experience genuine laughter, fun, and lightheartedness with your family? (1 = No joy / all serious duty; 10 = Frequent laughter and play)
Pillar 5 — Overall Physical and Mental Well-Being
*
Rows
1
2
3
4
5
6
7
8
9
10
Physical Fitness and Strength: How satisfied are you with your physical strength, body composition, and functional capability? (1 = Out of shape / physically hurting; 10 = Peak strength, mobility, and discipline)
Nutritional Discipline and Gut Health: How consistent are you with whole foods, hydration, and avoiding inflammatory eating? (1 = Erratic, poor fueling; 10 = Clean, high-performance nutrition)
Mental Clarity and Focus: How sharp and focused is your brain throughout the day, free of brain fog and chronic worry? (1 = Severe brain fog / scattered; 10 = Razor-sharp focus)
Daily Life Fulfillment: Looking at your life holistically, how grounded, peaceful, and fulfilled do you feel in who you are today? (1 = Surviving day to day; 10 = Thriving in purpose and peace)
Disconnection & Isolation Score
Sleep & Nervous System Recovery Score
Irritability & Emotional Regulation Score
Presence & Family Connection Score
Overall Physical & Mental Well-Being Score
Overall Baseline Climate Score
Spouse or partner email address (optional)
example@example.com
Submit
Should be Empty: