Monthly Accountability Journal

Your Name (required)

Your Email (required)

Date

1) To what extent (0-10, with 10 high) did you feel heard, understood and respected by me? Please list any comments you may have.

2) On a scale of 1-10 (10 being "thrilled," 5 being "Happy" and 0 being "Not happy at all") how happy are you with your progress this past month?

3) List any breakthroughs, realizations, or accomplishments you've made from our work together in the past month.

4) List anywhere that you got stuck, didn't accomplish what you'd hoped or hit a wall & what you attribute this to ( this could be helpful in preventing similar challenges in the future).

5) Are you willing to acknowledge your accomplishments and let go of any negative self-talk about what may have happened? What do you feel needs to be released?

6) List 2 goals you have set for yourself for the next 30 days.

7) Who or what do you need to put in place in order to help you achieve your goals?

8) List one thing you're going to attempt this month that is very new for you.

9) To what extent (0-10, with 10 high) are we making progress toward what you want to accomplish?

10) Do you have any recommendations for how this experience/program could be improved?

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