How blocked do you feel - Maria Evangelou | Personal & Professional Coaching

Questionnaire

From a scale of 1 to 5.
If 1 is the MINIMUM value and 5 is the MAXIMUM value, how would you rate yourself?

1. Do you GET STUCK in thoughts like you are not good enough?

1 2 3 4 5 None

2. How often do you find yourself doing repeated actions that you dislike/ prefer you didn’t do?

1 2 3 4 5 None

3. Do you feel that everything and everybody seem to be working against you?

1 2 3 4 5 None

4. How often do you feel you cannot cope?

1 2 3 4 5 None

Name your TOP 3 DESIRES

Write down what is it holding you back from EACH OF THEM.

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Last Name

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