online questionnaire.

So that we have a productive initial call session, please complete this online questionnaire. prior to our complimentary 15 minute iniital call session.

The online questionnaire is completly confidential.

let’s get to know a little bit about you.

    contact info.




    basic info.


    sex.

    level of education.

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    now let's learn more about you.

    on a scale of 1 to 10 with 10 being the highest, what number represents how you describe yourself.


    I am optimistic.
    12345678910
    I am satisfied with my life.
    12345678910
    I am satisfied with my health.
    12345678910
    I am satisfied with my financial situation.
    12345678910
    I am satisfied with my social life.
    12345678910
    I feel good about my personal relationships.
    12345678910

    what are your 3 most significant accomplishments?

    what are your 3 most significant disappointments?

    describe your top 3 strengths.



    describe your most aggravating weakness.



    i am happiest when i...



    i feel lowest when i...



    how would you describe you state of health?



    how would you describe your state of well-being?



    if i could do anything, i would...



    describe any goal(s) or desire(s) that you have yet to fulfill.



    what has hampered you from achieving your goal(s) or desire(s).



    people like me because i am...



    how did you hear about burchell coach?

    Please prove you are human by selecting the Car.

    all information contained within this questionnaire will remain confidential.