What is your age range? *

Where do you live? *

Which best describes your employment status? *

Entrepreneur (running your own business)

Corporate mom (working for a company)

Freelancer or self-employed

Stay-at-home mom (not currently working outside the home)

How many daughters do you have and how old are they?

Do you avoid taking action on opportunities because you're worried about what might go wrong? *

Always

Often

Occasionally

Never

How often do you second-guess decisions you’ve made? *

Always

Often

Occasionally

Never

Do you feel uncomfortable stepping out of your comfort zone in new situations? *

Always

Often

Occasionally

Never

How often do you feel paralyzed by the fear of making mistakes? *

Always

Often

Occasionally

Never

Do you tend to postpone big goals because you're worried you won't succeed? *

Always

Often

Occasionally

Never

Do you struggle to say "no" to requests, even if you're already overwhelmed? *

Always

Often

Occasionally

Never

How often do you prioritize others' needs over your own, even when it's inconvenient? *

Always

Often

Occasionally

Never

Do you feel guilty when setting boundaries, even if it's for your well-being? *

Always

Often

Occasionally

Never

How frequently do you agree to things just to avoid disappointing someone else? *

Always

Often

Occasionally

Never

Do you feel drained after trying to meet everyone else’s expectations? *

Always

Often

Occasionally

Never

Do you feel unsupported or alone in managing your responsibilities as a working mom? *

Always

Often

Occasionally

Never

Do you find it difficult to reach out for help or share your struggles with others? *

Always

Often

Occasionally

Never

How often do you feel overwhelmed by managing work, family, and your own needs? *

Always

Often

Occasionally

Never

Do you feel disconnected from yourself and your personal goals or dreams? *

Always

Often

Occasionally

Never

Do you feel like no one truly understands or relates to your daily struggles? *

Always

Often

Occasionally

Never

What is your single biggest concern as it relates to your health and wellness right now? *

We're tabulating your score. Please provide your contact information so that we can send you information about your results.

First Name

Email

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