Hi. This questionnaire is designed to be the first steps on the road to having more patience and control and being the mom you want to be. There are no right or wrong answers.

Some parts of this questionnaire might take courage. Take a breath. You can do this.

Your answers do not have to be perfect or complete — just go with the first thing that comes to mind and move through this form at a steady pace. If you find yourself stuck, move on to the next question. It will probably take about 20 minutes to complete.

If answering these questions make you feel shame, frustration or sadness, that is good news because it means you want to get better, and the more I can help you!

Follow the "stress-out rule:" If you feel that answering one of the questions will push you over the edge, if it will make you stress-out, simply skip it.