Create Space - Pre Coaching Assessment

1
Name* This field is required.
First Name
Last Name
2
Phone Number* This field is required.Please provide your mobile telephone number so I can add you to WhatsApp - the preferred method of DM communication during the programme.
Area Code
Phone Number
3
Email* This field is required.
example@example.com
4
On a scale of 1 to 10, how would you rate your overall sense of balance and control in your life right now? (* This field is required.
5
What are the 3 biggest sources of stress or overwhelm in your life right now?* This field is required.
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How many hours per week do you currently spend on tasks that feel unproductive or draining?* This field is required.
Less than 5 hours
5-10 hours
10-20 hours
More than 20 hours
7
Which areas of your life do you feel most overwhelmed or burnt out? (Select all that apply)* This field is required.
Work
Finances
Home / Family
Time Management
Personal health
Other (please provide details on next page)
8
If you selected 'other' on previous question, please provide details
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How would you describe your current ability to manage time and prioritise tasks?* This field is required.
Excellent
Good
Fair
Poor
10
Do you struggle with saying “no” to people or commitments that don’t align with your priorities?* This field is required.
Always
Often
Sometimes
Rarely
Never
11
How comfortable are you with asking for help or delegating tasks to others?* This field is required.
Very Comfortable
Somewhat comfortable
Uncomfortable
I rarely / never ask for help
12
Do you currently have boundaries in place to protect your personal time and energy?* This field is required.
Yes, and I enforce them consistently
Yes, but I find it hard to maintain them
No, I struggle to set and maintain boundaries
I'm not sure
13
What challenges do you face when it comes to saying no or setting boundaries?* This field is required.
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How often do you feel emotionally or mentally drained by your daily responsibilities?* This field is required.
Every day
A few times a week
Once a week
Rarely
15
On a scale of 1 to 10, how guilty do you feel when you prioritise your needs over others? (1 = no guilt, 10 = extremely guilty)* This field is required.
16
How do you currently manage feelings of stress, overwhelm or burnout?* This field is required. (Check all that apply)
Exercise
Meditation or mindfulness practices
Journaling
Talking to a friend or therapist
Avoidance (e.g., procrastinating, watching TV, etc.)
I don’t currently manage it
Other (please provide more details on next page)
Other
17
If you selected 'other' on previous question, please provide details
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What do you hope to achieve by the end of this 4-week coaching program?* This field is required.
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How would your life change if you could free up 10 or more hours a week?* This field is required.
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What is your biggest motivator for wanting to create more space in your life?* This field is required. (e.g., better work-life balance, more time for self-care, less stress, etc.)
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What would your life look like if you had more time and less overwhelm?* This field is required.Select all that apply
More time for self-care
More energy for family or relationships
Time to pursue hobbies or passions
Feeling less stress and more joy
Other (please provide details on next page)
22
If you selected 'other' on previous question, please provide details
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What do you hope to feel by the end of this coaching program?* This field is required.Select all that apply
Calm and in control
More balanced
More confident in managing time
Empowered to say “no” and ask for help
Other (please provide more details on next page)
24
If you selected 'other' on previous question, please provide details
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What habits or beliefs do you think are currently holding you back from being more organised and in control of your time?* This field is required.
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On a scale of 1-10, how committed are you to making the necessary changes to reduce overwhelm and reclaim your time?* This field is required. (1 = not committed at all, 10 = fully committed)
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Is there anything else you would like me to know before we begin the program?* This field is required.
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DON'T FORGET TO CLICK ON SUBMIT BELOW Thank you for taking the time to complete this questionnaire, I'll see you soon!
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