First Name * Last Name (Not required: you can choose to provide it for our initial meeting together) 1) I can name, appreciate, and embody my strengths * Not so confident Somewhat confident Very confident Extremey confident 2) I am aware of my challenges and what I tend to avoid * Not so confident Somewhat confident Very confident Extremey confident 3) I can identify my biases of attention and blind spots * Not so confident Somewhat confident Very confident Extremey confident 4) I can see patterns in the ways I act * Not so confident Somewhat confident Very confident Extremey confident 5) I can name what pushes my buttons and causes me to react * Not so confident Somewhat confident Very confident Extremey confident 6) I can identify what I do that causes other people to react * Not so confident Somewhat confident Very confident Extremey confident 7) I can describe what is happening internally when things upset me * Not so confident Somewhat confident Very confident Extremey confident 8) I have the skills to work with my internal reactions when things upset me * Not so confident Somewhat confident Very confident Extremey confident 9) I can name which values are most important to me and how they can differ from what others value * Not so confident Somewhat confident Very confident Extremey confident 10) When there is disagreement, I can describe how my motivations differ from others * Not so confident Somewhat confident Very confident Extremey confident Focus Areas Which of these areas (if any), interest you? We will certainly be tailoring our work together according to what matters most to you. Thank you for submitting your initial self-awareness survey! We’ll use it in our work together. I look forward to meeting you! Best wishes, Kerry Self-Awareness Exercise Prior to our initial meeting, you may find this exercise helpful for better understanding yourself. As we work together, taking the survey periodically may also allow you to gauge how (and whether) our sessions are benefiting you.
