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Questionnaire

Questionnaire

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With which of the following general areas do you require the most attention from a Communications Coach?
Select all that apply.Verbal communicationWritten communicationProfessional communicationInterpersonal communicationCognitive / thinking skillsOther
If 'other', please explain:
Example scenario:
Please share an example of when you were communicating and it did not go as you wanted.
Please check all the specific areas that stop you from communicating clearly
(NOTE: Everything you share here is completely confidential. Never share anything you are uncomfortable sharing, but please know that the more honest you are, the more Coach Kiki can help your brain change.)ADD/ADHDAddiction/AlcoholismAngerAnxietyAuditory ImpairmentAuthority IssuesAutism Spectrum DisorderBipolar DisorderCarelessnessConfusionDepressionDyslexiaEnergy LevelsEye ContactFearJealousyLack of KnowledgeNervousnessOCDOther Learning DisorderMental Health Challege(s) or Mood Disorder(s)OverwhelmPanic AttacksPhobia(s)Physical IssuesPoisePublic SpeakingProcessing EmotionsRageResentmentSchizophrenic DisorderSelf-ConfidenceSocial AnxietyStutteringUnknown BlocksVisual Impairment
Using the list above, please identify the top three challenges to your communication.
If there is only one area that you would like the most help on improving, please limit your response to that specific choice.
Check all the ways that ANY of the above issues affect your life:
I am sometimes late for appointments.I am frequently late for appointments.I am almost always late for appointments.I avoid certain events and situations even though I know they can help further my career or life success.I am dissatisfied with my life.I am chronically unhappy (though few would know it).I am chronically unhappy and I make those around me unhappy.I have had suicidal thoughts.I am currently or often feeling suicidal.
Please describe what your perfect life would look like if these challenges did not affect you.
Be as specific as you can think of, starting with waking up in the morning and ending with going to bed. Include both your personal and professional life areas.
On a scale of 0 to 10, with 10 being the most and 0 being none, how important to you is it to create your "perfect life"?
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