What’s Holding You Back?

How have you been feeling lately? *

A) Overwhelmed and tense most of the time

B) Like I keep repeating the same patterns

C) Disconnected or kind of numb

D) Mostly okay, but I feel like something’s missing

When life throws you a curveball, what’s your first thought? *

A) “Why does this always happen to me?”

B) “I need to fix this right now”

C) “I probably messed something up”

D) “This is tough, but I’ll figure it out”

What part of your life feels the most out of balance right now? *

A) Work or career

B) Relationships

C) Mental or emotional well-being

D) Family life or parenting

How do you usually handle uncertainty or change? *

A) I push back; I don’t like change

B) I try to control whatever I can

C) I shut down or avoid it

D) I stay open, but it’s not always easy

When it comes to figuring things out or growing as a person, you… *

A) Listen to podcasts or read, but don’t act on them

B) Have worked with a therapist or coach before

C) Try to handle everything alone

D) Are doing your best and open to more support

What would you love more of in your life right now? *

A) Peace and quiet

B) Direction and clarity

C) Energy and motivation

D) Time for myself

Name *

First Name

Last Name