How long before the divorce was filed was the relationship declining? *
Your answer
What were the reasons for the relationship declining? *
Your answer
Who filed for divorce? *
If you filed for divorce, what happened to cause you to commit to filing for divorce?
Your answer
Have you had thoughts of suicide either before, during or after the divorce? *
If you have children, please list their ages at the time of the divorce or type NA if not applicable. *
Your answer
Please describe any support system you had in place during the divorce (if any). *
Your answer
How did you manage your emotions during the divorce? (coping mechanisms, therapist, friends, family, etc.) *
Your answer
What were the results of this approach to managing your emotions? *
Your answer
Have you experienced any health problems or weight loss/gain due to divorce? *
Your answer
What responses to the divorce have you observed in your children? *
Your answer
How did your family respond to the news about your divorce? *
Your answer
How much detail have you shared with others about the circumstances leading up to and during the divorce? *
Do you feel like you've been able to express your emotions and feelings about the divorce to someone you trust? *
Have you lost any relationships as a result of the divorce (friends/family)? *
What sources of encouragement did you rely on during the divorce? *
Your answer
Looking back, do you feel like you did everything in your power to try to save your marriage? *
Looking back, what would you do differently in your marriage? *
Your answer
Looking back, what would you do different in your divorce? *
Your answer
Did you and your ex-spouse participate in marriage counseling at any point during your marriage? *
Do you have any regrets from the marriage? Explain. *
Your answer
Do you have any regrets from the divorce? Explain. *
Your answer
What is the relationship status of your ex-spouse? (remarried, seeing someone, living w/someone, etc.) *
Your answer
What's the ex-spouse's relationship like with the children now? *
Your answer
Describe how your relationship with your children has been effected by the divorce. *
Your answer
Are you seeing anyone at this time? *
Would you consider reconciliation with your ex-spouse? *
What are you most triggered by now? Share as many as you'd like! *
Your answer
What is your response to a trigger? Choose as many as you'd like. *
What emotions come up when you get triggered? Which do you struggle most to manage (put an asterisk) *
Your answer
Who and/or what is most triggering for you? *
Your answer
How long does it take for your reaction and emotions to settle down (until you feel in control again)? *
Your answer
How would you rate your emotional health right now? On a scale of 1-10 (1 being lowest). *
Your answer
How important is having a strong sense of emotional health, peace and joy restored to you?
On a scale of 1-10 (1 being lowest).
*
Your answer
What area(s) of life do you struggle the most? *
Required
Would you like to schedule a 30 minute complimentary coaching session?
This survey is anonymous. If you'd like to schedule a session with me, please go to my website at justflipthescript.com and click on the link titled "Schedule a Discovery Call." *