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* 1. What is your name?

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* 2. What is your email?

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* 3. How often do you feel stressed out, overwhelmed, burnt out?

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* 4. How often do struggle to tell people “no” at work?

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* 5. How often do you find yourself feeling less trusting of others?

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* 6. How often do you feel cynical at work?

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* 7. How often do you feel like you can never get caught up, like your day is not your own?

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* 8. How often do you feel resentful towards others for being demanding or inconsiderate?

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* 9. Please describe your previous attempts at setting boundaries.

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* 10. What do you think has not made you successful in the past?

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* 11. What do you hope to gain from this course? If you can, describe also what your new day-to-day will be like after this course.

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* 12. What else would you like to tell me?

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