Welcome to Chelsey Benzel's Confidence Assessment
Are you ready to take your confidence to the next level?

To become the most confident, radiant and sexy version of yourself?

Are you ready to put the struggle with your weight behind you for good and NEVER want to diet again because you're so in love with your body exactly as you are?
YES! I'm ready.
The Dalai Lama once said "The western woman will save the world." But what happens if the western woman is so consumed by the way she looks that she has little energy left to actually make a mark on the world?

Life is about so much more than looking a certain way, fitting into a certain dress size, or seeing a certain number on the scale. It’s about changing your mindset so you can accept your body exactly as it is now, and enjoy each moment to the fullest.

Let's get started and see where you're at now, shall we?

First things first, what is your name? *

Phone number (please include country and area codes) *

Which of the following apply to you now?

Rate how satisfied you are in each of the following areas:

Self esteem

Body Image

Romantic relationship

Relationship with parents and sibling(s)

Relationship with kids

(If not applicable just hit enter or scroll down)
Relationships with friends


Mental health

Physical health

Pleasure/sex life




Self talk

Relationship with food

Please rate how true the following questions are for you:

I feel guilty when I eat dessert.

I weigh myself daily

I feel confident in my skin.

My weight is constantly on my mind.

I feel supported in all areas of my life.

Are you happy with your relationships with your...

Romantic partner?

Kids? (if applicable. If not just hit enter)





What do you feel is most getting in the way of your happiness?

What do you feel is the reason for this?

What would you be doing differently if these obstacles no longer existed?

What have you learned about yourself in the past 12 months? (Are you determined, fearless, stubborn, resistant to change, etc.)

How do you see your life being different 1 year from now?

5 years from now?

10 years from now?

What are you willing to do to make sure these things happen? (E.g. make time for yourself daily, enlist support of a coach, invest in your self-improvement)

Why is it important for you to make these changes? (More confidence, Improved relationships e.g. more dates, intimacy, etc, better results in your career/business, etc)

What would your life be like if nothing changes and you stay on the same path you’re on?

How committed are you to becoming the most confident version of yourself?

What do you believe you need the most help with? (e.g. relationship with food, body image, confidence, relationships, etc.)

Have you ever worked with/are you currently working with a coach or counsellor? If so, please briefly describe their approach and area of expertise.

Are you willing to keep moving forward even if someone tells you it can’t be done, you don’t get the results you’re looking for right away, or you get tired making the necessary changes and are tempted to go back to old patterns?

Would you be interested in a one-on-one coaching session to eliminate the barriers standing in the way of your happiness and learn proven methods to increase your happiness?

That's it!!! Thanks for taking the Confidence Assessment. I personally read through each response. I'll be in touch soon to go over your results!

Thanks for completing this typeform
Now create your own — it's free, easy, & beautiful
Create a <strong>typeform</strong>
Powered by Typeform