Life Evaluation Form

Please complete the following questionnaire.

Name:

Email:

Date:



Grade yourself on each question where a selection means the following:
I Agree (10) ----- Indifferent (5) ----- I Do NOT Agree (1)


** Please answer ALL questions or your score will not be accurate! **

1) I'm working hard but not making enough money
 

2) I feel like something is blocking my success
 

3) I have good ideas but my follow-through needs help
 

4) Negative thinking causes worry, fear and anxiety in my life
 

5) I'm surrounded with great advisors in personal & business
 

6) I sometimes procrastinate and don't get things done timely
 

7) Negative thinking causes worry, fear and anxiety in my life
 

8) I know I could do better with a little help & direction
 

9) I don't spend enough time with family or taking care of myself
 

10) I tend to take care of others before my own wants and needs
 

11) If I could just get ahead in life I'd be so happy
 

12) I am not completely clear on my goals and direction in life
 

13) I could be much better with gratitude and appreciation
 

14) Having a success business partner could improve my life
 

15) Sharing new ideas without judgement is important
 














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