Pre-Diagnostic Form | Mars Venus Coach Tess Elsen

Name *

First

Last

Email *

Phone Number *

1. Communications *

Selected Value: 1

Please rate yourself on a 1 (low) – 10 (high) scale on the following:

2. Motivation/Passion/Enthusiasm *

Selected Value: 1

3. Sharing household tasks *

Selected Value: 1

4. Decision Making/Problem Solving *

Selected Value: 1

5. Managing Change *

Selected Value: 1

6. Time Management *

Selected Value: 1

7. Work/Life Balance *

Selected Value: 1

8. Sharing Leisure time/interests *

Selected Value: 1

9. Friends/socialising *

Selected Value: 1

10. Finances *

Selected Value: 1

11. Health *

Selected Value: 1

12. Outlook/Attitude *

Selected Value: 1

13. Spiritual *

Selected Value: 1

14. Trust and respect *

Selected Value: 1

15. Children responsibilities *

Selected Value: 1

Success!