Divorce Self Assessment by Irooze

Your Name* This field is required.

Email* This field is required.This is required to schedule a call with a Divorce Specialist.

example@example.com

Phone Number* This field is required.This is required to schedule a call with a Divorce Specialist.

Are you a:* This field is required.

Mom

Dad

Neither

What is your status?* This field is required.

Contemplating divorce

Separated

Divorced

What experience do you have with divorce?* This field is required.

My parents had an amicable divorce

My parents had a nasty divorce

I have heard horror stories from friends & family

None

Have you tried mediation?* This field is required.Select all that apply:

Yes, and it’s going well

Yes, but it’s not going well

No, I hired a litigation lawyer

No, the other parent does not want to go

No, the other parent hired a litigation lawyer

We are exploring this option but don’t know where to start

How old are you?* This field is required.

How many children do you have?* This field is required.

How old are your children?* This field is required.

How did you hear about us?* This field is required.Select all that apply:

Facebook

Google

Instagram

I was referred to you by

I was referred to you by:* This field is required.

Which country do you live in?* This field is required.

USA

Canada

Other Country

Specify which country* This field is required.

Select your province:* This field is required.

original Your province:

province text* This field is required.

Select the state you live in:* This field is required.

Specify your County, Town or City* This field is required.

Tell us briefly how you feel right now* This field is required.

Do you have a support system?* This field is required.This is a preliminary question to understand what you are going through during this strategy session with a Divorce Coach you will have the opportunity to explain or elaborate on your feelings and challenges. Select all that apply.

Friends

Family

I have a therapist

I am thinking of getting a Divorce Coach

What is a Divorce Coach?

I am too embarrassed to ask for help

I prefer to stay under the radar for now

I am window shopping

I don’t want anyone knowing that I am thinking about this

I don’t need a support system- I am fine on my own

Other

Support system - Other?* This field is required.Kindly share more details with us

Myself* This field is required.This is a preliminary question to understand what you are going through during this strategy session with a Divorce Coach you will have the opportunity to explain or elaborate on your feelings and challenges. Select all that apply.

I want to move forward with my life- I am looking for someone to help me think this through.

I tend to want to control the relationship and it’s not helping us at all.

I feel like I lost with my self identity and want to rediscover myself.

I want to start the divorce process – I don’t know where to start and who to speak with.

I would like things to get better in my relationship - I am looking for solutions.

Recommended to me (friends, family, therapist)

I am just exploring

I feel confident about this and I am not doubting myself at all

Other

Myself - Other* This field is required.Kindly share more details with us

Kids* This field is required.This is a preliminary question to understand what you are going through during this strategy session with a Divorce Coach you will have the opportunity to explain or elaborate on your feelings and challenges. Select all that apply.

How do I explain the reason for the divorce to my children in an age-appropriate way?

I am deciding if this is the right time for the kids.

How do I divorce with the least negative impact to my children?

How will my kids handle and cope with the divorce?

I am a stay-at-home mom/dad- could I or should I continue doing that?

I am wondering if & how I am equipped do this alone as a single parent.

I am not sure if I am comfortable and/or capable to be a solo parent.

I wonder if the other parent can handle being a single parent.

I don’t need help in this area

Other

Kids - Other* This field is required.Kindly share more details with us

My Mindset* This field is required.This is a preliminary question to understand what you are going through during this strategy session with a Divorce Coach you will have the opportunity to explain or elaborate on your feelings and challenges. Select all that apply.

I think that I have some work to do to improve

No matter what comes up, I am optimistic

I feel a lot of pressure

My mind is racing

I am struggling with a lot of issues

I have more sad days than happy days

I am ready to learn and challenge myself

I am ready and willing to change, if I need to

I am looking for strategies to help me cope with my current situation

I think that I’m in a good place now and I don’t need help in this area

I am not sure I am emotionally stable to make a move

I feel anxious, lonely and/or helpless

I wonder/worry if my community and family will judge me

I feel like a failure

I feel trapped

I feel that we both need to change but we are stuck

I feel confident about this and I am not doubting myself at all

Other

My Mindset - Other* This field is required.Kindly share more details with us

How are you feeling right now?* This field is required.Select all that apply:

😄 Happy

😢 Sad

😠 Angry

😟 Anxious

😌 Content

😎 Confident

😌 Relieved

How do you want to be feeling in 3-6 months?* This field is required.Select all that apply:

😄 Happy

😢 Sad

😠 Angry

😟 Anxious

😌 Content

😎 Confident

😌 Relieved

Finances* This field is required.This is a preliminary question to understand what you are going through during this strategy session with a Divorce Coach you will have the opportunity to explain or elaborate on your feelings and challenges. Select all that apply.

I am financially dependent on the other parent

I am not sure if I can afford to pay my own bills

I don’t know how to prepare a budget

I don’t think I can stick to a budget

I have never paid a bill – the other parent took care of it for us

I want to explore if I can reasonably afford the legal fees

I am ready to learn and challenge myself

I am looking for resources- I really want to keep the costs of this divorce as low as possible

I am looking for strategies to help me cope with my current situation

I know that with a little help, I can be financially comfortable and independent

I have no issues with my financial situation

Other

Finances - Other* This field is required.Kindly share more details with us

Spiritual* This field is required.This is a preliminary question to understand what you are going through during this strategy session with a Divorce Coach you will have the opportunity to explain or elaborate on your feelings and challenges. Select all that apply.

It is against my religion to divorce

I was raised to believe that marriage is sacred

No one in my family has divorced- I don’t want to be the 1st

I am losing my faith and it scares me

I worry that some family members will disown me

I am out of balance. Family is important to me but my freedom is more important

I am wondering if I can maintain my faith and remain happily married

I always wanted to stand by my marriage vows

I feel that that other parent and I are not in the same places anymore

My spirituality is not an area of concern right now

Other

Spiritual - Other* This field is required.Kindly share more details with us

Career* This field is required.This is a preliminary question to understand what you are going through during this strategy session with a Divorce Coach you will have the opportunity to explain or elaborate on your feelings and challenges. Select all that apply.

I am worried I will lose my job if my boss finds out

I don’t know if it makes sense to keep this job or if I should take something else

I wonder how I could handle my work hours and obligations when they interfere with my new home life as a single parent

I wonder if I can be a solo parent and perform well at work

I am a stay at home mom/dad- I need a job: where do I start, career vs job

I need to drop my work hours/travel so that I am more available to my children

I am considering whether this job will allow for the flexibility I need in my home life

I am used to having help - without a 2nd pair of hands, I am not sure how I can do this

I feel that that other parent and I are not in the same places anymore

I am not concerned about my career or job situation

Other

Career - Other* This field is required.Kindly share more details with us

Are you a stay at home Mom or Dad?* This field is required.We are delighted to have various options and tailor-made services to ensure you remain aligned with your needs

YESNO

If you are a stay at home Mom or Dad with no income, what is your family income?* This field is required.Why are we asking this question? To offer you the most optimal results, we have created programs that satisfy each income bracket.

Under $100,000

$100,000- $200,000

$200, 000- $300,000

$300, 000- $400,000

$400,000 +

What is your personal income bracket?* This field is required.Why are we asking this question? To offer you the most optimal results, we have created programs that satisfy each income bracket.

Lower than $60k

$60,000-$80,000

$80,000-$100,000

$100,000-$200,000

$200,000+

What is your Occupation?* This field is required.Why are we asking this question? To offer you the most optimal results, we have created programs that satisfy each income bracket.

Employee

Small Business Owner

Junior Manager

Senior Manager

Senior Executive

Other

Would you like free resources?* This field is required.We will send you articles and videos from our divorce library related to any of these in your state/province:

Legal

Financial

Emotional

Real Estate

Parenting

Mindset and Self Development

Career

Technnology

Other

Who would you like referrals to professionals in your region?* This field is required.We know how hard it is to find the "right" professional for you! These vetted and trusted divorce-trained professionals are HEART-centered. They care about you and your family. Select all that apply:

Looking for a Lawyer

Looking fro a Mediator

Looking for a Collaborative lawyer

I'm exploring going Pro Se/Self Representation

I already have a lawyer

Yes, help me with my financial situation: budgeting, reviewing settlement offer, tax implications, understanding numbers...

Real Estate team: to buy and/or sell, qualifying for a new mortgage

I am emotional, overwhelmed, confused, scared...

Help with my mindset and self development

Parenting, Co-parenting and Co-existing

Career / Job situation

Technology-based issues

No, thank you. I do not require any referrals right now

Other

How would you like us to send you the information?* This field is required.

Send it via email

Send it via text message

Other

Schedule your free strategy call with a Divorce Specialist to discuss your challenges and requirements in more detail* This field is required.** Click on SUBMIT to access our calendar

YES, Please!

I am not ready right now to speak with anyone

I prefer to save your info and contact you when it's a better time for me : info@irooze.com

No, thank you

Would you like to share anything else with us?Including your worries, concerns or questions. We are here for YOU!