5E Capacity Check
A gentle snapshot of where you are right now — across five dimensions of whole-person capacity.
Before You Begin
This short check covers ten questions across five areas. For each one, choose a number from 0 to 5 that best reflects how you are right now — not how you think you should be.
0 = not at all · 5 = fully and consistently
Your scores are for practitioner use only. There are no right or wrong answers — just honest ones.
The 5E Capacity Check
Rate each statement from 0 (not at all) to 5 (fully and consistently).
E1 · Focus & Follow-Through
I can focus on what matters, make decisions, and follow through on my intentions without becoming overwhelmed or scattered.
E2 · Boundaries & Self-Direction
I set and hold boundaries with ease, and I feel in charge of my time, energy and choices rather than driven by others' demands.
E3 · Emotional Regulation
I can feel my emotions without being overwhelmed by them, and I recover from upsets without it taking a long time or a lot of effort.
E4 · Connection & Safety
I feel safe in my relationships and able to be honest about how I feel. I don't often feel alone with what I'm carrying.
E5 · Body Awareness & Comfort
I feel reasonably comfortable in my body, aware of its signals, and able to respond to what it needs — rest, movement, nourishment.
E6 · Physical Resilience
My body recovers well from exertion, illness or stress. I generally feel physically capable of meeting the demands of my daily life.
E7 · Vitality & Stamina
I have enough energy to engage with life. I don't feel chronically depleted, flat or running on empty most of the time.
E8 · Stress Recovery
After a stressful period, I can genuinely rest and restore. I don't stay in a heightened or wired state for long after the pressure has passed.
E9 · Meaning & Direction
I have a sense of purpose or direction in my life. I know — at least broadly — what matters to me and why I'm doing what I'm doing.
E10 · Inner Steadiness
Even when life is hard, I have some sense of inner ground — a part of me that feels stable, okay, or able to find its way through.
Your Scores & Optional Context
Please use the form below to submit your 0–5 ratings for each of the ten statements above, and add any optional context that feels useful for Carolyn to know.
Your scores are for practitioner use only and will not be shared.
Thank You for Completing Your Intake
You have now completed all three pages of your Harmoniance client intake. Carolyn will review everything carefully before your first session together.
If you have any questions in the meantime, please don't hesitate to get in touch.
Email CarolynEverything you share is kept private and used only to support our work together.
