2. What's your current occupation? Why are you dissatisfied?

3. Your "dream" job(s)?

4. How did you hear about our web site? (please select!)
Word of Mouth/Friend Search Engine(which one?) ---- Google ---- ---- Alta Vista ---- ---- Excite ---- ---- HotBot ---- ---- Yahoo ---- ---- Go To ---- ---- others ---- Publication Other sources

5. If from search engines, what engine and keyword(s) did you use?

6. If from a friend, publication, or other source, please identify.

7. Please tell us: (A) something about yourself, (B) including your current career, (C) what you've done to change your career, (D) the outcome of any recent job interviews, and (E)anything else you think we should know.

8. If you decide that you may be interested in our career counseling services -- after discussion with Dr. Rosen, upon further reflection, or both -- what delivery method would you prefer:

face-to-face counseling (in our New York City offices: 1776 Broadway at 57th Street)?
distance counseling (using telephone, video-phone, internet, e-mail)?
combination of face-to-face and distance counseling?

9. You may compare yourself to "career change champions" -- people who have changed careers often, easily, happily, and successfully -- by using the following short Scale or long Inventory; each makes explicit those career attitudes and career behaviors we have found to be hallmarks of high-functioning, successful, and satisfied career-changers. Please select and fill in either the "Career Change Ability Scale" (takes about 5 minutes to complete) or the "Career Well-Being Inventory"(about 20 minutes to complete.)

5-minute Scale
20-minute Inventory (recommended)
Neither

Celia Paul Associates, Inc.
Premium Career Management for Doctors
1776 Broadway, Suite 1806
New York, NY; 10019-2002
Phone: (212) 397-1020
Fax: (212) 397-1022