Self-Assessment Forms
Before You Book Your Free 30-Minute Discovery Call
These assessments help us both understand what kind of support would be most helpful for you at this time.
My role is as a wellness coach—not a therapist—so this step ensures you’re matched with the right kind of care for your current needs.
During our call, we will:
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Clarify urgent issues – Which feel most pressing right now?
(Examples: burnout, emotional eating, alcohol, procrastination, anxiety, sleep) -
Set 90‑day goals – Specific, measurable, realistic goals.
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Map potential barriers – Identify what might make these goals challenging.
Submitting Your Assessment Results
Important:
When you book your free 30-minute discovery call, please include your answers and any notes in your confirmation email. This ensures we can make the most of our time together and focus on what matters most to you.
FIRST ASSESSMENT
A brief self-assessment that reflects how you’ve been feeling over the past two weeks.
click here: Beck’s Depression Inventory
Important:
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A score above 21 does not mean you have a diagnosis, but it may indicate that professional evaluation is needed. A psychiatrist or licensed therapist can guide you on next steps—whether that’s therapy, medication, or other forms of support.
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A score of 21 or below means we can proceed with scheduling your first session.
SECOND ASSESSMENT
Please rate your current level of difficulty in each area on a scale from 0 to 10:
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0 = Not a concern
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10 = Severe concern
Important:
If you rate 6 or higher in any area, please provide additional details so I can better understand your experience. You may write your responses on paper, take a picture and attach them to the email, or type them into a Word document.
Areas to Rate:
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Anxiety
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Health Issues
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Stress
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Insomnia / Sleep Issues
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Procrastination
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Low Motivation
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Emotional Regulation
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Anger Management
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Disordered Eating
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Body Image Concerns
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Alcohol Misuse
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Addictions (please list)
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Burnout / Overwhelm
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Depression
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Physical Activity
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Daily Energy Level
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People Pleasing
ONLY IF YOU SUSPECT OR HAVE AN EATING DISORDER
click here: Eating Disorder Questions (scroll down on that web page)
Important:
If you answer “yes” to more than four questions in your questionnaire, please seek professional help before we begin.
If you are already receiving professional guidance, we can proceed with your free discovery call.
Wellness Coach
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Focuses on future goals, behavior change, and lifestyle optimization
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Works with areas like stress, burnout, energy, sleep, productivity, self-care, and habit building
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Uses tools like accountability, mindset shifts, and routine design
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Does not diagnose or treat mental health conditions
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Best for people who feel stuck, want to make lifestyle changes, or need structured support