Assessment Form

Name
Address
City
State
Zip
E-mail
Phone

How did you hear about us?



What specifically is working?

(For example: I'm successful at paying bills on time, doing laundry, locating keys, etc.)

What specifically is not working?

(For example: The bills are paid late, important papers are not filed away, incoming mail is not read promptly, etc.)


What items are most important to you?

(For example: Financial papers, photographs, collections, business information, paying bills, etc.)


How will you know when you are organized?

What's causing the disorganization?


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