Client Struggles Assessment
Help us understand your main challenges so we can support you effectively.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Which area(s) of your life or work are you seeking support with?
*
Career/Workplace
Relationships
Health/Well-being
Finances
Personal Growth
Other
Please describe your main struggle(s) or challenge(s) in your own words.
*
How would you rate the severity or impact of your main struggle(s)?
*
Not severe
1
2
3
4
5
6
7
8
9
Extremely severe
10
1 is Not severe, 10 is Extremely severe
Which struggle is your top priority to address right now?
*
What would success look like for you after overcoming these challenges?
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