Self-Reflection Assessment
Rate from 0 to 10 how much you believe each statement.  0 means you do not believe it at all and 10 means you completely believe it.
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Your Name *
Your Phone Number *
Your Email *
Today's date *
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I believe in myself. *
I don't believe it at all.
I completely believe it.
I am just as valuable as other people. *
I don't believe it at all.
I completely believe it.
I would rather be me than someone else. *
I don't believe it at all.
I completely believe it.
I am proud of my accomplishments. *
I don't believe it at all.
I completely believe it.
I feel good when I get compliments. *
I don't believe it at all.
I completely believe it.
I can handle criticism. *
I don't believe it at all.
I completely believe it.
I am good at solving problems. *
I don't believe it at all.
I completely believe it.
I love trying new things. *
I don't believe it at all.
I completely believe it.
I respect myself. *
I don't believe it at all.
I completely believe it.
I like the way I look. *
I don't believe it at all.
I completely believe it.
I love myself even when others reject me. *
I don't believe it at all.
I completely believe it.
I know my positive qualities. *
I don't believe it at all.
I completely believe it.
I focus on my successes and not my failures. *
I don't believe it at all.
I completely believe it.
I am not afraid to make mistakes. *
I don't believe it at all.
I completely believe it.
I am happy to be me. *
I don't believe it at all.
I completely believe it.
Overall, how would you rate your self esteem on the following scale? *
I completely dislike who I am.
I completely like who I am.
What would you need to change in order for you to move up one point on the OVERALL scale.  (For example, if you rated yourself a 6, what would you need to do to rate yourself a 7?) *
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