SECTION B: WHO IS THIS ASSESSMENT FOR?

This assessment is for:

MyselfMy childMy spouse/partnerMy familyMy organization / team

SECTION C: CURRENT LIFE STAGE

Which category best describes you / the person concerned?

Child (3–12 years)Student (13–21 years)Adult / Working ProfessionalParentCouple / FamilyCorporate / Team

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SECTION D: CHALLENGES & CONCERNS

What challenges are you currently facing? (Select all that apply)

Academic difficultiesCareer confusionLow confidenceEmotional stress or anxietyParenting challengesRelationship issuesWorkplace stressDecision-making confusionI feel “stuck” in lifeOther (please specify)

How long have you been facing these challenges?

Less than 6 months6 months – 1 yearMore than 1 year

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SECTION E: LEARNING & BEHAVIOR OBSERVATION

Which best describes the learning style?

Learns better by seeing (visual)Learns better by listeningLearns better by doingNot sure

Do you feel your true strengths are currently being used?

YesNoNot sure

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SECTION F: GOALS & EXPECTATIONS

What do you want clarity on most right now?

Career directionChild’s potentialLearning styleEmotional balanceRelationship understandingSelf-awarenessParenting approach

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SECTION G: AWARENESS OF DMIT

Have you heard about DMIT before?

YesNo

What made you interested in DMIT or Palmayan?

WebsiteReferralSocial MediaGoogle SearchOther

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SECTION H: CONSENT & NEXT STEP

Are you open to a personal counselling session after assessment?

YesMaybeNot at the moment

Preferred mode of session:

OnlineIn-person

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