Let’s get to know you

So we can help you better

Thank you for reaching out!

This short intake form helps us understand where you are, what you're facing, and how we can best support you.

Everything you share is confidential and will only be seen by our coaching team.

We know this step might feel big, but you’re not doing it alone.

You’re taking the first real step toward healing, clarity, and control.

After you complete the form below,

you'll be able to book your free 1-on-1 call

with a member of our team.

Please complete all required fields and be as honest as you feel comfortable.

✨ 1. Basic Information

🔍 2. Your Current Life Situation

Which of the following best describes your current relationship status? (Select all that apply)

I am still in the relationship but exploring options to leave safely.

I have recently left the relationship.

I am going through a divorce or separation.

I am dealing with custody or legal battles.

I am out of the relationship but still healing.

Other (please describe):

Do you feel safe in your current environment?

Yes

No

Sometimes

If "No" or "Sometimes," please share any safety concerns you'd like us to be aware of:

💪 3. Where Are You on Your Healing Journey?

(Select the option that best describes your current experience):

I’m still in the relationship and want to plan a safe exit strategy.

I’ve left the relationship but am now facing legal battles (e.g., divorce, custody, or smear campaigns).

I’ve been out of the relationship, but I’m still struggling emotionally, feeling stuck, or unsure how to fully heal and rebuild my life.

I’m not sure how to describe it — I just know I need help and support.

Other (please describe):

Can you share a bit more about what you’re currently facing or what kind of support you’re seeking?

📑 4. Legal or Co-Parenting Challenges (if applicable)

Are you currently navigating legal issues related to your past relationship?

Yes

No

If yes, please briefly describe (e.g., divorce, custody, restraining orders):

Are you co-parenting with a narcissistic ex-partner?

Yes

No

What is your biggest co-parenting challenge right now?

🌟 5. Coaching Goals & Readiness

What are you hoping to achieve through coaching? (Check all that apply)

How ready are you to commit to your healing journey? (1 = Just exploring, 5 = 100% committed)

💬 6. Final Notes

Is there anything else you’d like me to know before we connect?

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested, as well as marketing and promotional messages, including special offers, discounts, new product updates among others. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

Disclaimer: I am not an attorney licensed to practice law in the state of Georgia or any other state. I do not provide legal services or legal representation. Services are limited to non-legal coaching (organization, state specific research, communication coaching, emotional support, preparation assistance, logistics). For legal advice, consult a Georgia attorney or your state-specific attorney.

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