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Create Space Pre Coaching Assessment
This quick assessment helps me understand where you're at and what you need most right now. Be honest, there are no wrong answers. It'll make our coaching sessions much more focused and impactful!
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1
Name
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First Name
Last Name
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2
Phone Number
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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
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3
Email
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example@example.com
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4
On a scale of 1 to 10, how would you rate your overall sense of balance and control in your life right now? (
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5
What are the 3 biggest sources of stress or overwhelm in your life right now?
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6
How many hours per week do you currently spend on tasks that feel unproductive or draining?
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Less than 5 hours
5-10 hours
10-20 hours
More than 20 hours
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7
Which areas of your life do you feel most overwhelmed or burnt out? (Select all that apply)
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Work
Finances
Home / Family
Time Management
Personal health
Other (please provide details on next page)
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8
If you selected 'other' on previous question, please provide details
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9
How would you describe your current ability to manage time and prioritise tasks?
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Excellent
Good
Fair
Poor
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10
Do you struggle with saying “no” to people or commitments that don’t align with your priorities?
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Always
Often
Sometimes
Rarely
Never
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11
How comfortable are you with asking for help or delegating tasks to others?
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Very Comfortable
Somewhat comfortable
Uncomfortable
I rarely / never ask for help
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12
Do you currently have boundaries in place to protect your personal time and energy?
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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
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13
What challenges do you face when it comes to saying no or setting boundaries?
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14
How often do you feel emotionally or mentally drained by your daily responsibilities?
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Every day
A few times a week
Once a week
Rarely
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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)
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16
How do you currently manage feelings of stress, overwhelm or burnout?
*
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(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
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17
If you selected 'other' on previous question, please provide details
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18
What do you hope to achieve by the end of this 4-week coaching program?
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19
How would your life change if you could free up 10 or more hours a week?
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20
What is your biggest motivator for wanting to create more space in your life?
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(e.g., better work-life balance, more time for self-care, less stress, etc.)
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21
What would your life look like if you had more time and less overwhelm?
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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)
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22
If you selected 'other' on previous question, please provide details
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23
What do you hope to feel by the end of this coaching program?
*
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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)
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24
If you selected 'other' on previous question, please provide details
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25
What habits or beliefs do you think are currently holding you back from being more organised and in control of your time?
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26
On a scale of 1-10, how committed are you to making the necessary changes to reduce overwhelm and reclaim your time?
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(1 = not committed at all, 10 = fully committed)
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27
Is there anything else you would like me to know before we begin the program?
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28
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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