Application to Work With Us

Helping Parents Reconnect with their Children

***WATCH THIS 1 Minute Video First - Then Fill Out This Application To Work w/Get Them Back***

What title best describes you?* This field is required.Mom, Dad, Grandparent, Step-Parent, etc.

How many children are rejecting you?* This field is required.

1 Child

2 Children

3 Children

4+ Children

What age range is your child or children?* This field is required.

Young Child (12 & Under)

Teenager (13-19)

Young Adult (20-30)

Adult (30+)

What are your ALIENATED Children's Names and Ages?

How much access do you have to your child or children?* This field is required.

NONE

NONE (Legally Prohibited)

Extremely Limited

Limited

Full Access

How long have you been rejected? (Approximately)* This field is required.

6 Months or Less

1 Year or Less

2 Years

3 Years

4+ Years

10+ Years

20+ Years

Which problems are you dealing with? (Select all that apply)* This field is required.

Child Being Told Lies

Brainwashing

Blocked Access

Gaslighting

Family & Friends Cut Out

Intercepting Communications

Told I Abandoned Them

Alienator Monitoring Communication

Child is Angry at Me

NONE of the Above

Rate your confidence in your ability to communicate effectively with them? * This field is required.0 is NO confidence at all. 100 is 100% confident.

Choose the ONE biggest challenge you are facing?* This field is required.

How to COMMUNICATE

How to Establish TRUST Again

How to REBUILD a Relationship

How to Get Them to ENGAGE

What areas do you need help in (Select all that apply)* This field is required.

Knowing what to SAY and NOT to say

How to explain myself better

Show that I am a good, loving parent

Clarity on how to move forward and help my child see what's going on

Create lightbulb moments of discovery

Help them realize they have been mentally and emotionally abused

Return the relationship to how it used to be

Understand their point of view, and share my perspective

Know what to say on the phone or in messages

How to communicate if I've been blocked or intercepted

Become a part of their life again and be involved

NONE of the above

Briefly describe your situation with only the most important details so we can best determine if we can help you. * This field is required.

In one sentence, what is your biggest obstacle right now?* This field is required.

We know this rejection takes an emotional toll on you. Which of the following are you dealing with?(Select all that apply)* This field is required.

Stress

Anxiety

Depression

Grief

Anger

Frustration

Resentment

Feeling lonely & isolated

Trouble Sleeping

Health Issues

Strain on other relationships

Impact on Job Performance

Loss of concentration

Physical Pain

NONE of the above

Rate your level of fear or anxiety when you think about trying to reconnect?* This field is required.0 is NO fear at all. 100 is 100% fear.

Choose the ONE biggest issue you are dealing with?* This field is required.

Guilt

Anger

Sadness

Confidence

How has this affected your identity and self-worth as a parent?* This field is required.

Which areas would you like to improve in emotionally and mentally? (Select all that apply)* This field is required.

Rebuild my self-esteem

Gain more control

Overcome anxiety and sadness

Be more confident

Feel calm and peaceful

Release anger

Let go of guilt or shame

Feel powerful again

Control my emotions

Build stronger beliefs

NONE of the above

What do you think your relationship will look like in 3 years if nothing changes?* This field is required.

Would you like a step-by-step communication plan to follow to help turn things around?* This field is required.

YES! That's what I need

No, I'm figuring this out myself

Would you like new strategies to communicate even if you've been blocked, ignored or intercepted?* This field is required.

YES! That's what I want

Would you like strategies to improve your confidence and control your emotions, so you feel empowered as a parent?* This field is required.

YES! I need this.

Do you want a completely new approach you can use immediately?* This field is required.

YES! That's what I want

What's your name?* This field is required.

First Name

Last Name

What's your email address?* This field is required.We will use this to reply to you.

example@example.com

Finally, what’s your phone number?* This field is required.

Based on your situation, what are your biggest fears? (Select all that apply)* This field is required.

I’ll never see my child again

Everyone will turn against me

I will fall into a spiral of sadness and depression

I’ll miss out on sharing a life with them

My child will think I am bad or evil

My efforts will be seen as me “buying their love”

My child won't know how much I love them