form page – Keeler Thomas Management

"*" indicates required fields

Name*

First Last

Email*

Phone*

		Rating	Gap
1	Each family member is confident they have a voice within our family and permission to assert themselves	Importance * Please enter a number from 1 to 5. Achievement * Please enter a number from 1 to 5.
2	Family members are able to approach each other with an outward focused mindset	Importance * Please enter a number from 1 to 5. Achievement * Please enter a number from 1 to 5.
3	Our family knows and is aligned with the basic principles and values needed to obtain what matters most	Importance * Please enter a number from 1 to 5. Achievement * Please enter a number from 1 to 5.
4	We have a plan that mentors the family and future generations with shared experiences that support our values	Importance * Please enter a number from 1 to 5. Achievement * Please enter a number from 1 to 5.
5	Our family communicates well and is effective at discussing sensitive topics	Importance * Please enter a number from 1 to 5. Achievement * Please enter a number from 1 to 5.
6	Our family has developed the ability to resolve upsets in a positive, unifying way	Importance * Please enter a number from 1 to 5. Achievement * Please enter a number from 1 to 5.
7	Our family has united behind a specific list of shared values that supports or sustains our individual values	Importance * Please enter a number from 1 to 5. Achievement * Please enter a number from 1 to 5.
8	Our family meets regularly, and intentionally, for family fun, growth, and individual development	Importance * Please enter a number from 1 to 5. Achievement * Please enter a number from 1 to 5.
9	I have identified my values that guide my purpose, integrated them into my life, and share them with the people who are important to me	Importance * Please enter a number from 1 to 5. Achievement * Please enter a number from 1 to 5.
10	We have developed a process for our family to make decisions together and act upon them	Importance * Please enter a number from 1 to 5. Achievement * Please enter a number from 1 to 5.
11	We have recorded what matters most for ourselves and our family to accomplish in life.	Importance * Please enter a number from 1 to 5. Achievement * Please enter a number from 1 to 5.
12	We have a plan in place that creates the genuine transfer of family leadership	Importance * Please enter a number from 1 to 5. Achievement * Please enter a number from 1 to 5.
Total Gap:

Discovery:	Questions 1,5,9	Total Score {{ discoverScore }}. For more information click here
Unity:	Questions 2,6,10	Total Score {{ unityScore }}. For more information click here
Vision:	Questions 3,7,11	Total Score {{ visionScore }}. For more information click here
Governance:	Questions 4,8,12	Total Score {{ governanceScore }}. For more information click here

Submit