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One on One Performance Intake Form

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Question 1 of 11

What's your name and where are you joining us from?

Question 2 of 11

What's your preferred contact method? Cell phone or email? Please provide it below!

Question 3 of 11

How often do you find yourself being pulled between multiple tasks at once, unable to commit to any one thing?

A

All the time

B

Often but not all the time

C

Here and there

D

Never

Question 4 of 11

How much do you currently have on your plate?

A

Lots I feel pulled in all directions!

B

A lot but I’m just about managing

C

A moderate amount nothing I can’t handle

D

I currently have very little on my plate

Question 5 of 11

How overworked are you?

A

Extremely

B

Pushing it pretty hard but managing

C

Moderately I work a lot but it’s totally fine

D

Not overworked at all

Question 6 of 11

How many times per week do you take time off to recover? Think sauna, yoga, getting a massage.

A

Everyday

B

About 3-5 times per week

C

1-3 times per week

D

It's very rare I get a chance to recover

Question 7 of 11

How clear are you about how to create your ideal life?

A

Crystal

B

I have a general idea

C

It's pretty hazy

D

I have zero clarity

Question 8 of 11

How difficult is it for you to turn off?

A

Extremely

B

It's tough but I can do it when I really need to

C

Moderately difficult

D

I can "turn off" pretty easily

Question 9 of 11

How anxious do you feel day to day?

A

I’m anxious almost every second of the day

B

I'm pretty anxious

C

Here and there

D

I don't feel anxious at all

Question 10 of 11

Which of the following scenarios do you most resonate with?

A

Everything is moving so fast, I can barely keep up, I’m emotionally and psychologically exhausted from work.

B

I’m really struggling to focus on one thing, I don’t know what I want or how I would even get it.

C

I’m running on cortisol and adrenaline I can’t switch it off, I never have enough time for everything on my plate, I’m physically drained I always feel the need to take a nap.

Question 11 of 11

Do you prioritize and organize your time or does life just unfold (and sometimes run you over)?

A

I plan and organize everything in my life

B

I’m definitely in the driver’s seat but could be more organized.

C

I’m moderately organized

D

Everything in my life just seems to happen and sometimes runs me over

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