Client Application

Name *

First Name

Last Name

Phone

(###)

###

####

Preferred Contact Method *

Call

Text

Email

What currently keeps this high-conflict situation ongoing? *

Select all that applly.

Co-parenting arrangement

Shared business/professional relationship

Family obligation

Legal proceedings (divorce, custody, etc.)

Financial entanglement

Shared property/assets

Other

Which areas of your life are most affected? *

Select all that apply

Mental/emotional wellbeing

Physical health

Career/work performance

Other relationships (family, friends)

Parenting ability

Financial stability

Sleep and daily functioning

Other

What is your availability for sessions? *

Select all that apply.

Weekday mornings

Weekday afternoons

Weekday evenings

Weekends

Flexible

Please confirm you understand: *

I understand that coaching is not therapy, legal advice, or financial counseling

I understand the cancellation policy (no same-day cancellations except emergencies)

I understand that payment is required in advance of sessions

I am committed to doing the work required to create change in my situation