ReRooted™ Reunification Coaching Waitlist & Intake Form

ReRooted™ Reunification Coaching Waitlist & Intake Form
Thank you for joining the waitlist. ReRooted™ Reunification Coaching is a trauma-informed, relationship-centered support program designed to guide families through reconnection and repair after separation, disruption, or high-conflict transitions. Our coaching approach integrates therapeutic insight with structured tools to rebuild trust and clarity between caregivers and children.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What best describes your situation?
Are you currently involved with DSS, Family Court or another agency?
What is the age range of the child(ren) you are working toward reconnecting or reunifying with?
Interested in:
Preferred Format:
What area or county do you currently live in?
Are you interested in the full 6-week ReRooted™ Program?
Would you like to receive additional resources while you wait?
What are your main goals or concerns with reunification?
How soon are you hoping to begin?

Other
Should be Empty: