How did you hear about us?
Rate the following as it applies to you:
10 highest (This is NOT a problem in my life. I'm doing really well with this.)
5 mid (This is SOMEWHAT of a problem in my life.)
1 lowest (This is a BIG problem in my life. I’m not doing well with this.)
How long have you had these challenging issues?
When the issue is at its worst, how does it affect your team?
Does this affect your team's: