Personal Plan Background Info Form
Name
First Name
Last Name
Email
example@example.com
How did the breakup happen?
What was happening emotionally leading up to the breakup?
What has happened since the breakup?
What have you previously done to try to improve things with your ex? And what results did your efforts bring you?
What do you think your ex’s emotional state is right now? How do you think they feel?
What do you think is stopping your ex from getting back together with you (emotionally)?
How have you personally been dealing with the breakup? What have you been doing since?
Where are you emotionally, right now?
What have you done to make sure that your ex isn’t walking back into the same relationship they walked out of in the first place? Please provide as much detail as possible (for example, if you've been going to therapy, what has your experience been?)
What is happening right now that is causing you to seek out coaching for your situation? Name at least 3 goals that you wanted to work on (other than getting your ex back)?
Tell me all other necessary details you think I need to know about your situation
Any other specific questions or concerns you want addressed in your personalized plan?
Submit
Should be Empty: