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Discovery Questionnaire

Overview:

Name
Today's Date

PART 1 | Let’s Begin with You

3. How would you currently assess your personal health on a scale of “poor” to “amazing”?
PoorFairNeutralGoodAmazing
Physical
Poor
Fair
Neutral
Good
Amazing
Emotional
Poor
Fair
Neutral
Good
Amazing
Mental
Poor
Fair
Neutral
Good
Amazing
Spiritual
Poor
Fair
Neutral
Good
Amazing
Financial
Poor
Fair
Neutral
Good
Amazing

PART 2 | FAMILY

6. How would you currently assess the relational health of your:
N/APoorFairNeutralGoodAmazing
Marriage
N/A
Poor
Fair
Neutral
Good
Amazing
Children
N/A
Poor
Fair
Neutral
Good
Amazing
Parents
N/A
Poor
Fair
Neutral
Good
Amazing
Siblings
N/A
Poor
Fair
Neutral
Good
Amazing
In-laws
N/A
Poor
Fair
Neutral
Good
Amazing
Extended Family
N/A
Poor
Fair
Neutral
Good
Amazing
Church/Community
N/A
Poor
Fair
Neutral
Good
Amazing

PART 3 | WORK

PART 4 | QUESTIONS & COMMENTS

THANK YOU FOR ANSWERING THESE QUESTIONS.

We are eager to hear your hopes, questions, concerns and perspectives when we meet soon.