Intake Form – Divorce Support Program

Thank you for trusting me to walk alongside you on this journey!

This form helps me understand your unique situation so I can provide the best possible support. Your information will remain private and confidential.

Thank you for trusting me to walk alongside you on this journey!

This form helps me understand your unique situation so I can provide the best possible support. Your information will remain private and confidential.

Divorce Coaching Intake Form

Contact Information

Full Name *

Email *

Phone *

Best method of contact (phone/email/text) *

State of Residence *

Family Details

Are children involved? *

Yes

No

If yes, please list how many and their ages

How long have you been married? *

Do both you and your spouse currently work? *

Yes, both work

Only one works

Neither currently working

Property & Finances

Do you and your spouse own your home together? *

Yes

No

Other

Do you and your spouse share other significant assets (e.g., retirement accounts, businesses, investments)? *

Yes

No

If yes, please describe

Legal Representation

Do you currently have an attorney? *

Yes

No

In the process of finding one

Has your spouse retained an attorney? *

Yes

No

Unsure

Safety & Support

Is your physical or emotional safety currently in jeopardy? *

Yes

No

Unsure

If yes, would you like resources for safety planning?

Yes

No

Do you have a support system (friends, family, therapist, support groups)? *

Yes

No

Limited

Goals & Support Needs

What are your biggest concerns right now regarding your divorce process? *

What outcomes or goals are most important to you moving forward? *

How do you hope coaching will support you on this journey? *

Consent & Confidentialit

I understand that divorce coaching provides emotional support, guidance, and resources but does not replace legal, financial, or mental health services. *

Yes

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