Transforming Divorce from Conflict to Clarity

Certified coaching to help you approach divorce with calm, confidence, and clarity.

Client Intake Form

All information is completely confidential. Never to be sold or shared

Personal Information

Name *

Address

Street Address

City *

State *

Country

Postal code *

Email *

Phone *

Best Method of Contact: *

Text

Call

Email

Date of birth *

Name of (ex) Spouse/Partner: *

Emergency Contact name/number: *

Your Current Situation:

How did you hear about us/who or what motivated you to meet with me? *

How would you describe your current relationship with your (former) partner? *

How do you think your (former) partner would describe the relationship with you? *

Is this your first, second or more marriage? *

What other people have you met with so far? (Please check all that apply) *

Therapist

Lawyer

Financial Planner

Other (specify below)

if other please specify:

Do you have children? (Please list names and ages) *

Living Situation: *

With partner

Without partner

Own/Rent? *

Own

Rent

Your Concerns and Goals

What are your three biggest concerns and most important outcomes that you have? *

Additional Information

Anything else you’d like to share as we begin this process? *

Are you in fear for your safety or for the safety and well-being of others in your household? (Please check one) *

Yes

No