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What feelings or thoughts come up for you when thinking about giving to, serving or helping others (family, friends, clients, strangers…)?

(Check all that apply even if they are opposite.)
 
Love
 
Joy/Excitement/Happiness
 
Connection/Bonding
 
Gratitude
 
Kindness
 
Natural and Easy
 
Apprehension
 
Obligation/Responsibility
 
Exhausting/Depleting
 
Irritation/Frustration
 
Anxiety/Stress
 
Anger
 
Other
 

 
 
 
What feelings or thoughts come up for you when you think of receiving or asking for help (ex. receiving money, help, support, etc.)?

(Check all that apply even if they are opposite.)
 
Love
 
Joy/Excitement/Fun
 
Connection/Bonding
 
Gratitude
 
Natural and Easy
 
Apprehension/Hesitation
 
Rather do it or get it myself
 
Don't trust it will be done right if I don't do it
 
Guilt
 
Unworthy
 
Fear/Anxiety/Stress
 
Anger

 
 
How much would you agree/disagree with the following:
Strongly Disagree Disagree Somewhat Disagree Neutral Somewhat Agree Agree Strongly Agree
Work-Life Balance is a problem for me
Having Work-Life Balance is important to me
I have a strong support system
I allow my support system to help me regularly
I have stress related to work/business
I have stress related to family responsibilities
I feel stress trying to balance business/career with family
 
 
 
In what areas of life do you feel you have sacrificed for family responsibilities?
(Check all that apply)

 
 
Financial/Monetary
 
Business Growth/Career Advancement
 
Health/Fitness/Physical Well Being
 
Spirituality/Moments of Contemplation
 
Emotional Well Being/Stress Levels
 
Hobbies/Passions/Quality time with Self
 
Other
 

 
 
 
In what areas of life do you feel you have sacrificed for business/career/work? (Check all that apply)
 
Quality Time With Spouse/Partner
 
Quality Time with Children
 
Connection with Extended Family
 
Spirituality/Moments of Contemplation
 
Health/Fitness/Physical Well Being
 
Emotional Well Being/Stress Levels
 
Hobbies/Passions/Quality Time with Self

 
 
 
Describe how a balanced life (successful business and family) would look for you.
   
 
 
 
How do you know when your professional and personal life are out of balance/harmony?
   
 
 
 
What is your most important, most pressing question or concern around business-family balance?
   
 
 
On a scale of 1-10, how much are the following people directly involved with or separate from your business or career endeavors, dreams and goals.

 
1. Completely Separate - Never discuss 2. 3. 4. 5. We talk on occasion about it 6. 7. 8. 9. 10. Very Involved - Partnership
Your Spouse/Partner
Your children
Extended family
Friends
 
 
How likely are you to sign up for an offer that teaches you the secrets of growing a profitable business/career in harmony with a happy home life?



(How likely are you to choose each for of the offer?)


 
Very Likely Likely Neutral Unlikely Very Unlikely
Book (free)
Book (paid)
E-book (free)
E-book (paid)
Webinar/Teleclass (free)
Webinar/Teleclass (paid)
In-person Workshop/Class (free)
In-person Workshop/Class (paid)
Overall
 
Kali Clarity Coaching