ECOTHERAPY QUESTIONNAIRE

Please complete this form before our first session.

How would you rate the following areas of your life right now, in terms of happiness, feelings of fulfilment and satisfaction? All answers are strictly confidential between Coach and Client.

(1=low satisfaction, 5=high satisfaction)

Feeling connected to others and the world around meFeeling connected to others and the world around me
Life FulfilmentLife Fulfilment
Feeling in touch with my intuition, heart, sensesFeeling in touch with my intuition, heart, senses
Having a place of belongingHaving a place of belonging
Being able to regulate my emotions and soothe my feelingsBeing able to regulate my emotions and soothe my feelings
Feeling appreciation for where I am and what I haveFeeling appreciation for where I am and what I have

Thank you