Welcome to Health Coaching with Angie!
This is your Mastery Survey this for will help me assess how i can best support you as your coach. This is 1 of 4 Forms.
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Client: First & Last Name *
Date: *
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Motivation Assessment
High Autonomy/ High Motivation ( Discretion over what you do, Being allowed to choose when you do things, Being allowed to choose how you do things, Discretion over who you work/play with) ~ Low Autonomy/ Low Motivation ( Being forced to do something not of your own choice, Being told when something must be done, Being told how something must be done, Being told who you must work or play with)
Part 1 Autonomy: the state of being not controlled by others. Discretion over who work with/play with.
Never (0)
Rarely (1)
Once week (2)
Every day (3)
How frequently do you feel as if you know ex- actly what you are supposed to do?
How frequently do you feel as if you perform tasks well?
How frequently do you feel confident in what you do?
How frequently do you feel as though you could teach others what you do?
Tyhjennä valinta
Part 2 Autonomy: the state of being not controlled by others. Being told who you must work or play with.
Never (0)
Rarely, If ever (1)
Once a Week (2)
On a daily basis (3)
How frequently do you get to choose what you do?
How frequently do you get to choose how you do things?
How frequently do you get to choose when you do things?
How frequently do you get to choose with whom you do things?
Tyhjennä valinta
What is your total in points for Motivation:
What does your score say about you?
Score 10-12: Very high autonomy/ Score 7-9: Moderately high autonomy/ Score 4-6: Moderate low autonomy/ Score 3 or less: Very low autonomy
Barriers to Autonomy
1.       Who do you feel restricts your autonomy the most?
2.       What events or circumstances in life most restrict your autonomy?
3.       What places most restrict your autonomy?
Increasing Autonomy
1.       Identify three steps to increase the amount of control you have over what you do.
2.       Identify three steps to increase the amount of control you have over when you do things.
3.       Identify three steps to increase the amount of control you have over how you do things.
4.       Identify three steps to increase the amount of control you have over with whom you do things.
Motivation Assessment cont'd
High Mastery/ High Motivation ( Performing a task that you know well, Knowing exactly how to do something) ~ Low Mastery/ Low Motivation ( Feeling intimidated by a task, Feeling unclear about the steps to take when performing an activity)
Mastery: Having full command or understanding of a subject
Never (0)
Rarely (1)
Once a week (2)
Every day (3)
How frequently do you feel as if you know ex- actly what you are supposed to do?
How frequently do you feel as if you perform tasks well?
How frequently do you feel confident in what you do?
How frequently do you feel as though you could teach others what you do?
Tyhjennä valinta
What is your total in points for Motivation:
What does your score say about you?
Score 10-12: Very high autonomy/ Score 7-9: Moderately high autonomy/ Score 4-6: Moderate low autonomy/ Score 3 or less: Very low autonomy
Barriers to Mastery
1.        What internal factors (fear, intimidation, lack of trust) most stand in the way of your sense of mastery?
2.       What external factors (people, places, things) most stand in the way of your sense of mastery?
Build Mastery
1.        What three steps can you take to overcome the internal barriers to mastery?
2.       What three steps can you take to overcome the external barriers to mastery?
Purpose: a fixed intention in doing something: an aim or goal
Motivation Assessment cont'd
High Mastery/ High Motivation (Feeling connected to those around you, Feeling as if your efforts have a measurable impact, Feeling as if your efforts are appreciated by those around you) ~ Low Mastery/ Low Motivation (Feeling detached from those around you, Feeling as if your efforts do not matter, Feeling as if your efforts are not appreciated by those around you )
Unique Purpose
1.        When do you feel most connected to those around you?
2.       When do you feel as if your efforts matter the most?
3.       When do you feel as if your efforts are appreciated the most?
4.       When do you feel as though your efforts have the most impact?
Increase Purpose
1.        What steps can you take to increase the sense of connection to those around you?
2.       What three steps can you take to increase the importance of your actions?
3.       What three steps can you take to increase the appreciation your actions are given?
Purpose in the Larger context
 Who do you feel would most support your actions/efforts?
What steps can you take to connect yourself more to this person or organization?
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