Needs Assessment

This is a quick exercise to help you identify where you are now at on each of these dimensions.

For a more in depth assessment is recommended to think of the last 6 months to a year from now.

Sign in to Google to save your progress. Learn more
Email *
Name and last name *
1. My Energy Levels *
The lowest possible
The highest possible
2. Feeling inspired *
The lowest possible
The highest possible
3. Having fun or joy. *
The lowest possible
The highest possible
4. Self-Honesty *
The lowest possible
The highest possible
5. Feeling at peace or calm *
The lowest possible
The highest possible
6. Feeling Heard or Seen *
The lowest possible
The highest possible
7. Feeling Accepted and Understood *
The lowest possible
The highest possible
8. Friendship *
The lowest possible
The highest possible
9. My Physical Appearance *
The lowest possible
The highest possible
10. Feeling Loved and Appreciated *
The lowest possible
The highest possible
11. My Environment (home, work, etc.) *
The lowest possible
The highest possible
12. Physical Health *
The lowest possible
The highest possible
13. My Feelings and Emotional Health *
The lowest possible
The highest possible
14. Organisation and Simplicity *
The lowest possible
The highest possible
15. Being Challenged and Stretched *
The lowest possible
The highest possible
16. Learning and Personal Growth *
The lowest possible
The highest possible
17. Money/Finances *
The lowest possible
The highest possible
18. Ability to connect with myself. *
The lowest possible
The highest possible
19. Relaxing and Looking after myself *
The lowest possible
The highest possible
20. What surprised you the most about your responses? *
21. What patterns or themes do you notice? *
22. What are the 3 things, that if you were to change, would have a great impact in your life? *
23. What's one change you could make that would give you more peace & calm?" *
24. What do you secretly know you need to say 'No' to? *
25. What do you need to stop saying 'Yes' to? *
26. What are you going to DO differently? *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy