I toyed with making these questions multiple choice, because it makes the form easier to complete, but I didn't want to influence your answers with that sort of constraint. With that said, answers don't need to be lengthy, and I'm not making any of them required.
Thank you for being a client and for taking the time to fill the form out!
(Can be physical, mental, emotional, routine, etc.)
(This could be communication, tools, scheduling, accountability, whatever)