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Self-esteem assessment form

self esteem assessment form

Think you could help your clients with their self-esteem? The Self-esteem Assessment Form is your new best tool.

If you're a Life Coach, Business Coach, or Consultant, you know how crucial self-esteem is. It can make or break personal growth, business success, even relationships and health.

Use this form to better understand where your clients are coming from. It's handy, it's insightful, and it's ready for you to use. Let's dive in!

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Questions to include on your Self-esteem assessment form

1. Personal Information

This section helps in gathering the basic information about the individual taking the assessment.

  • What is your name?
  • What is your age?
  • What is your gender? (Male, Female, Non-binary, Prefer not to say)

These questions are designed to get a general understanding of the individual's self-esteem.

  • How often do you feel confident in your abilities? (Always, Most of the time, Sometimes, Rarely, Never)
  • Do you feel valued and appreciated? (Always, Most of the time, Sometimes, Rarely, Never)
  • How often do you compare yourself with others? (Always, Most of the time, Sometimes, Rarely, Never)

Understanding the frequency of self-comparison is crucial as it can often contribute to low self-esteem if it becomes a regular habit.

3. Experience in Social Settings

These questions aim to understand the individual's self-esteem in social contexts, which is often where self-esteem issues can manifest most prominently.

  • How comfortable do you feel in social situations? (Very comfortable, Comfortable, Neutral, Uncomfortable, Very uncomfortable)
  • How easy do you find it to express your opinions when you disagree with others? (Very easy, Easy, Neither easy nor difficult, Difficult, Very difficult)

Understanding the comfort level in social situations can help in identifying social anxiety issues, which are often linked with low self-esteem.

4. Personal Achievement and Failure

These questions help to understand how the individual perceives their achievements and failures, which can significantly impact self-esteem.

  • How do you usually react when you experience a failure?
  • When you achieve something, do you feel proud of yourself? (Always, Most of the time, Sometimes, Rarely, Never)

The perception of failure and the ability to take pride in achievements are key determinants of self-esteem. Thus, these questions are vital in assessing the individual's self-esteem.

5. Body Image

Body image can have a significant impact on self-esteem, thus these questions aim to understand the individual's perception of their physical self.

  • Are you satisfied with your physical appearance? (Yes, No)
  • If no, what aspects of your physical appearance are you unhappy with?

The body image questions are important as dissatisfaction with physical appearance can significantly lower self-esteem.

Other question ideas

When you are creating your Self-esteem assessment form, here are some additional questions you may want to consider. These won't apply in every case, but should give you some ideas as you build out your form.
  • How much do you agree with this statement: "I have a positive relationship with myself." (Strongly agree, Agree, Neutral, Disagree, Strongly disagree)
    • This question gives insight into the individual's self-relationship. A positive relationship with oneself usually indicates high self-esteem.
  • Is there anything you would like to change about your personality? If yes, what and why?
    • This question can provide an understanding of how much they accept themselves as they are or if they wish to change some aspects of their personality, indicating possible low self-esteem.
  • How much do you agree with this statement: "I can handle most things that come my way." (Strongly agree, Agree, Neutral, Disagree, Strongly disagree)
    • This question assesses the individual's self-efficacy, which is an important aspect of self-esteem. High self-efficacy often means high self-esteem.
  • How often do you forgive yourself when you make a mistake? (Always, Most of the time, Sometimes, Rarely, Never)
    • The ability to forgive oneself for making mistakes can show a healthy level of self-esteem. Difficulty with self-forgiveness may suggest low self-esteem.
  • How much do you agree with this statement: "I deserve to be treated with respect." (Strongly agree, Agree, Neutral, Disagree, Strongly disagree)
    • This question assesses the individual's self-respect. A high level of self-respect often indicates high self-esteem.
  • How comfortable are you with saying "No" to things you don't want to do? (Very comfortable, Comfortable, Neutral, Uncomfortable, Very uncomfortable)
    • This question can indicate whether the individual has the ability to set boundaries. Difficulty in saying "No" may suggest self-esteem issues.
  • How much do you agree with this statement: "I am able to balance my needs with the needs of others." (Strongly agree, Agree, Neutral, Disagree, Strongly disagree)
    • This question evaluates the individual's ability to balance personal needs and the needs of others. The inability to balance these needs can be an indicator of low self-esteem.
  • How satisfied are you with your level of independence? (Very satisfied, Satisfied, Neutral, Dissatisfied, Very dissatisfied)
    • This question assesses the individual's level of independence. A high level of satisfaction may suggest high self-esteem as independence is often linked to a strong sense of self.

Things to consider

  1. Privacy and Confidentiality - This form involves sharing personal information and feelings, which some people might be uncomfortable with. Make sure to inform users upfront about how their information will be used and stored, and ensure that your form complies with all relevant privacy laws and regulations.
  2. User-friendliness - To make the form easy to fill out, keep the instructions clear and concise, use simple language, and ensure that the form is visually appealing. You should also consider making the form responsive, so it's easy to fill out on any device.
  3. Validation and Error Messages - Use HTML5 form validation to ensure that all required fields are filled out correctly. If a user makes a mistake or misses a field, provide clear, helpful error messages to guide them to correct the error.
  4. Scoring System - Given that this is an assessment form, consider implementing a scoring system. This will help quantify the responses and make it easier to understand the level of self-esteem of the person.
  5. Optional Comment Sections - Since some questions might require more detail, consider adding optional comment sections to allow users to elaborate on their answers.
  6. Providing Support - If a user's responses indicate low self-esteem, it's important to provide resources for professional help or support. This might include links to mental health services or a message advising the user to seek professional help.
  7. Proper Flow and Grouping - Questions should be logically grouped and follow a coherent flow. This will help users respond more accurately and make the form more efficient to complete.

How to create your Self-esteem assessment form

Now that you know what questions you should include, it's time to build your form!

The only problem is that traditional forms tools are inefficient.

People will forget to fill out your form. They'll get stuck halfway and not be able to finish it. Or they'll send you the wrong stuff. You end up wasting hours chasing people down over email. 

That's why you should give Content Snare a try. 

Content Snare is packed with advanced features that will have you hours:

  • Automatic reminders - Remind people to complete their form with fully customizable reminders.
  • Reject incorrect information - If a single question is filled out incorrectly, ask your client to re-do just that one item.
  • Autosaving - No progress gets lost. People can fill out forms in multiple sittings.
  • Comments and questions - If the person filling the form gets stuck, they can ask a question without having to email you.

Give it a go by signing up for your free 14-day trial

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