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Client Intake Questionnaire

This questionnaire helps us conduct a structured Performance Autopsy.

Your responses allow us to reconstruct the event, identify failure modes, and design concrete countermeasures.

There are no “right” answers. Specificity improves accuracy.

All responses are confidential.

Contact Information

Full Name

Email Address

Event Overview

What event are we analyzing?

What event are we analyzing?
A
B
C
D
E

When did it occur?

How high were the stakes of this event?

How high were the stakes of this event?
A
B
C
D

What outcome were you expecting?

Subjective Experience

What actually happened?

At what point did you realize things weren't going well?

How prepared did you feel going in (1–10)?

How prepared did you feel going in (1–10)?
Not at all preparedCompletely prepared

What do you believe were the main reasons this didn’t go as expected?

Was there anything you noticed during the event that felt off or different from practice?

What artifacts do you have?

What artifacts do you have?
A
B
C
D
E
F

Goals Going Forward

What matters most right now?

What matters most right now?

On a scale of 1–10, how distressed are you about this outcome right now?

On a scale of 1–10, how distressed are you about this outcome right now?

Is there any context you haven’t mentioned that you think is important for us to understand?