Needs Assessment Survey (web)

2.Welcome to your Needs Assessment Survey

The following survey is a needs assessment tool, specifically designed to be used as part of a coaching engagement.

Please complete this whilst holding your everyday experience of your own reality.

As a strengths-based model, the survey asks about the four recognised areas of human needs (Survival, Safety, Social and Self).

Completing this survey will enable you and your coach to look at you and your current way of being, through the eyes of human strengths and potentials. It will enable your coach to identify your strengths, talents and resources that can be tapped and more fully utilised for self-actualisation.

A Coaching Room coach will be in touch soon via email or phone to set up a time for your complimentary session.

Before you begin, please take a moment to access your best and most genuine and open state of mind... thank you, please begin!
1.What is your full name?(Required.)
2.What is your email address?(Required.)
3.Please enter your contact phone number(s)(Required.)
4.SURVIVAL NEED; SLEEP

How in your life would you describe your sleep?
(Required.)
5.SURVIVAL NEED; FOOD

How would you describe your use and relationship to food?
(Required.)
6.SURVIVAL NEED; WEIGHT MANAGEMENT

How is your own weight management?
(Required.)
7.SURVIVAL NEED; EXERCISE

How would you describe the level of exercise?
(Required.)
8.SURVIVAL NEED; SEX

How would you describe the level and your relationship to sex?
(Required.)
9.SURVIVAL NEED; MONEY

How would you describe your relationship to money?
(Required.)