Pansophix - Family and Friend's Questionnaire

Family and Friends Questionnaire

You can use this questionnaire to give feedback to a family member or friend who has asked you for feedback. To be as helpful as possible please answer as many questions as you feel comfortable with and be completely honest.

Your Name:
Please leave blank if you would like to remain anonymous.

Your Family Member or Friends's First Name:

Your Family Member or Friends's Email Address:
(your feedback will be sent to this email address)

1. What would you say are his/her most positive beliefs about himself/herself?

2. What would you say are his/her most negative beliefs about himself/herself?

3. What three adjectives would you use to describe him/her?

Adjective 1:

Adjective 2:

Adjective 3:

4. If he/she had a choice between listening and speaking the choice would be?

5. What do you find most irritating about him/her?

6. When was the last time you and he/she had a really serious conversation?

7. How do you know when he/she is upset or worried about something?

8. Does he/she ask others for help or try to do everything themselves?

9. What would you say is his/her usual reaction to sudden changes to plans?

10. What would you say is his/her usual reaction to requests to do something he/she does not like doing?

11. What would you say is his/her usual reaction to lack of money?

12. How does he/she tend to handle setbacks and disappointments?

13. If he/she is engrossed in doing something is it easy to get his/her full attention?

14. Does he/she text or call other people when he/she is spending time with you?

15. When you are with him/her how does he/she make you feel?

16. Are there things you avoid talking with him/her about? If 'Yes' it may help if you indicate what they are.

17. What would you like to see him/her doing more of?

18. What would you like to see him/her doing less of?

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Family and Friends Questionnaire