Are You Shut In? The purpose of this questionnaire is to help you identify your need for confidential coaching due to experiencing unresolved trauma resulting from sexual assault or rape.

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QUESTIONNAIRE

Have you ever been or are you a victim of sexual assault or rape?

What is the one thing you are trying to do to overcome the sexual assault or rape you have experienced?

What is your goal to be free from being SHUT IN: Silently Hurting due to Unresolved (Rape/Sexual Assault) Trauma Internalizing Needlessly?

What is the one thing you need to accomplish to be free in the next 90 days?

What is the biggest obstacle that is preventing you from achieving that one thing?

What is the one thing you can do to solve this problem?

What are you afraid will happen if you do not resolve the trauma you experienced from sexual assault or rape?

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