KCC - Work/Business - Life Balance Survey

What feelings or thoughts come up for you when thinking about giving to, serving or helping others (family, friends, clients, strangers…)?

(Check all that apply even if they are opposite.)

Love

Joy/Excitement/Happiness

Connection/Bonding

Gratitude

Kindness

Natural and Easy

Apprehension

Obligation/Responsibility

Exhausting/Depleting

Irritation/Frustration

Anxiety/Stress

Anger

Other

What feelings or thoughts come up for you when you think of receiving or asking for help (ex. receiving money, help, support, etc.)?

(Check all that apply even if they are opposite.)

How much would you agree/disagree with the following:

	Strongly Disagree	Disagree	Somewhat Disagree	Neutral	Somewhat Agree	Agree	Strongly Agree	N/A
Maintaining balance between business/work and family is a challenge for me

Having or finding balance is important to me

I have a strong support system

I allow my support system to help me regularly

I tend to do everything myself

I feel stress/overwhelm related to work/business

I feel stress/overwhelm related to family responsibilities

I feel guilty when I do business away from my children

I feel guilty when I do business away from my spouse/partner

When I am with my kids and/or partner, at least a part of me is thinking about business/work

When I am doing business/work, at least a part of me is thinking about my kids and/or partner

I feel stress/overwhelm trying to balance business/career and family

In what areas of life do you feel you have sacrificed for family responsibilities?
(Check all that apply)

Financial/Monetary

Business Growth/Career Advancement

Health/Fitness/Physical Well Being

Spirituality/Moments of Contemplation

Emotional Well Being/Stress Levels

Hobbies/Passions/Quality time with Self

Other

In what areas of life do you feel you have sacrificed for business/career/work? (Check all that apply)

Quality Time With Spouse/Partner

Quality Time with Children

Connection with Extended Family

Spirituality/Moments of Contemplation

Health/Fitness/Physical Well Being

Emotional Well Being/Stress Levels

Hobbies/Passions/Quality Time with Self

Other

What do you need in order to feel that your life is in balance and successful?

How do you know when your professional and personal life are out of balance/harmony?

What aspect of business and/or family is most stressful/frustrating/overwhelming? Tell me an issue that you would LOVE to have professional support in solving?

On a scale of 1-10, how much are the following people directly involved with your business/career endeavors, dreams and goals.

How likely are you to sign up for an offer that teaches you the secrets of growing a profitable business/career in harmony with a happy home life? (Particularly with spouse/partner and/or children)

(How likely are you to choose each for of the offer?)