Client Intake Survey For | ConneXions Coaching

#	EDIT	Client Name	Date Created	Date Updated	Created By (User)	Survey Analysis
#	EDIT	Client Name	Date Created	Date Updated	Created By (User)	Survey Analysis

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Client Name(Required)

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Survey Analysis

My life is working very well

I can express my feelings clearly and easily

I know how to set effective personal boundaries

I am comfortable becoming appropriately vulnerable

I believe I am fine, just the way I am now

Blaming others is easier than taking responsibility

I believe I am not lovable/

I am good enough

I treat myself with compassion

I know what I want my life to look like

I am not good enough

I am not worthy

I am not lovable

I need to be prefect

It is OK to make mistakes

I have close friends I can trust and be honest with

I feel lonely much of the time

I don't really trust anybody

I belong to one or more supportive communities

I madidate on a regular basis

I am frequently depressed

I use recreational drugs too heavily

I have a connection with something greater than myself

My life is well balanced

I drink alcohol too much

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