Accountability Check-In

Let's review how this week has been going for you and think about steps you could take in the next few days!

Please complete this form to

First name*

How are you feeling regarding steps toward your goals this week?

Tell me what you're feeling good about. Describe steps you've taken in the right direction. *

Which goal(s) are you stuggling with? Ex.- Health, social, academic, organizational...please describe. *

What do you think has gotten in the way of your success? *

Forgetfulness

Lack of motivation

Distractions- TV/friends

Distractions- Phone/social media

Laziness

Lack of time

Lack of energy

Anxiety or depression

Sick

Avoidance

Disorganization

Other (describe): __________________________________________________________________

Have you tried strategies we've talked about? Please describe what you've tried. *

What do you think you could do that might help you get back on track? *

Do you think a quick call/text could be helpful?

Name one or two goals that you'd really like to accomplish between now and our next appointment. *

682.337.9390

Use tab to navigate through the menu items.

bottom of page