Dr. Linda Rivera: Better Life By Design

ASSESSMENT

Coaching vs Psychotherapy Assessment

To help determine which one is right for you, indicate (T)rue or (F)alse to the 25 following statements. The last 3 statements allow you to give a detailed response. Print a copy for your records before pressing the submit button. Once you press the submit button, both you and Dr. Rivera will receive your responses by e-mail. Dr. Rivera will follow-up with you by e-mail within 48 hours.

My energy is low

TrueFalse

I can get panicky and find it hard to breathe

TrueFalse

I feel depressed

TrueFalse

I want to make positive changes in my life

TrueFalse

I have so much energy that I can go days without sleeping

TrueFalse

I sometimes 'freeze' or 'zone out'

TrueFalse

I no longer feel like doing the things I used to like to do

TrueFalse

I don't feel like eating (or I have been overeating)

TrueFalse

I have been crying a lot

TrueFalse

I have recently been diagnosed with a severe/chronic medical illness

TrueFalse

I have trouble falling asleep or staying asleep

TrueFalse

I have a problem with drugs or alcohol

TrueFalse

I have been feeling easily annoyed or angry with people

TrueFalse

I think the future holds so much promise

TrueFalse

I have financial problems

TrueFalse

I feel like now is the time for me to take action to have a better life

TrueFalse

I have been fired from my job

TrueFalse

I can follow through on something when I set my mind to it

TrueFalse

I have legal problems

TrueFalse

I like to get feedback from other people to help me solve my problems

TrueFalse

I have nightmares

TrueFalse

I have had a recent death in the family

TrueFalse

I enjoy learning new things about myself

TrueFalse

I am in an emotionally/physically abusive relationship

TrueFalse

I have trouble concentrating

TrueFalse

The problem is:

I feel:

What I think would help is:

Your Name:
Your Email:

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