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* 1. Which issue do you struggle with most? Please select one:

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* 2. On a Distress Scale of 1-10, how severe are your symptoms? Please check:

  Low Distress 1 2 3 4 5 6 7 8 9 High Distress 10
Level of Intensity

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* 3. How long have you struggled with this issue? (How many months? How many years?)

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* 4. What other solutions have you tried? Check all that apply to you:

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* 5. Out of all of the solutions you have tried, which has been most helpful to you in the past? (Please explain your answer)

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* 6. What are your biggest frustrations or challenges as you try to overcome your anxiety or depression? Check all that apply to you:

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* 7. Out of all the frustrations and challenges you face as you try to overcome your anxiety or depression, which has been most difficult? (Please explain your answer)

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* 8. If you could sit with me and ask me any question about overcoming anxiety or depression, what would be the two top questions on your list?

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* 9. How would you like my help? Please rank them.

  1st 2nd 3rd 4th
I would like to be able to work with you one-on-one (via individual coaching calls)
I would like to attend a group training with you in the Northwest USA
I would like digital tools so I can work independently/privately (via workbook, ebook, etc)
I would like to work and be supported in an on-line group environment (via teleseminars/webinars)

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