PERSONAL DYNAMIC ASSESSMENT

NAME:

ADDRESS:

PHONE:                                 CELL:                         

FAX:                                       E-MAIL:

REFERRED BY WHOM:

In Your Life:

     1.     Tell me about youself and your family. How many years are you married?   

     2.     How old are your children, etc.?

     3.     Do you and your family encourage each other and exhibit mutual love and respect?

     4.     Do you demand and expect excellence from yourself and your family?

     5.     Who is in charge and determines financial undertakings?

     6.     What is the best and worst part of family life?

     7.     Describe yourself and your attitude in different settings.

     8.     Do you recover easily from setbacks and obstacles?

     9.     What is your frustration level?

    10.     Are you comfortable in social situations or do you prefer to not participate?  

    11. Are you a good listener? Are you a good communicator?

    12. What are your goals?  6 months/1 year/5 years.

    13.  Have you achieved your goals to date? Are you on the correct path for  your future?

    14. What do you do for enjoyment and personal satisfaction?

   15.  Are you financially secure?

   16. If you could change things…what would those things be…and how would you make them better if the choices were yours?

 

 

 

In Your Profession:

    1.      What is your title and what are your responsibilities?

    2.     What type of work are you involved in?

    3.     Is your work clearly defined?

    4.     Do you get satisfaction from your work?

    5.     What are your goals? 6 months/1 year/5 years What level have you achieved at work?

     6.     Are you committed at work or are you seeking new opportunities?

     7.     Do you follow through and solve problems or procrastinate?

     8.     Are you a good listener? Are you a good communicator?

     9.     Are you a relationship builder and team player or do you work better alone?

   10.  Do you recover easily from setbacks and obstacles?

   11.  What is your frustration level?

   12.  Do you leave work responsibilities at work or do you bring them home?

   13.  Does work interfere with your personal relationships with family and friends?

   14.  What does customer satisfaction mean to you?

   15.  What are the major problems that you encounter and how would you change things to make them better if the choices were yours?