• Who are you here as?*
  I’m a founder / co-founder running the companyI’m a founder post-exit / stepped back / between companiesI’m not a founder, but I’m struggling and I want personal supportI’m HR / LD / People leader
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• If you take away the story, what’s really hurting right now*
  My body feels on edge (sleep, exhaustion, adrenaline, panic-energy)My mind feels loud or numb (dread, emptiness, looping thoughts)My relationships feel fragile (distance, conflict, trust erosion)The business is on fire — but I’m personally fine
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• Which one feels uncomfortably accurate right now?*
  Stage 1 – Warning: Nothing is ‘wrong’ on paper, but I can feel the cost stacking upStage 2 – Fatigue: I’m still performing, but I’m more reactive and less presentStage 3 – Exhaustion: I’m functional, but barely. I’m avoiding decisions and second-guessing myselfStage 4 – Breakdown: Something already broke or forced a stop. I’m rebuilding — and scared of sliding backStage 5 – Collapse: I’ve crashed / shut down. I don’t know how to get back up to stability
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• Name*
  First NameLast Name
• Email*
  example@example.com
• Where did you find this?*
  Please Select LinkedIn Google Referral Event Email Podcast Website Other
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• In the last 14 days, the cost has shown up most as… (select the dominant one)*
  I’m restless late at night and struggle with low energy when I wake upI’m sharper and more frustrated around loved ones than I want to admitI’m ‘fine’ all day, then crash and my mood suddenly drops when I’m aloneI’m working more to keep myself distracted from deeper feelings I’d rather not confront
• In the last 14 days, I’ve been normalizing these early warning signals (select the dominant one)*
  Sleep disruptions that would have worried me a year agoNeeding more stimulants (caffeine, nicotine, etc) to feel like myself and make it through the dayNumbing myself (scrolling, alcohol, overeating, etc.) to come down and relaxFeeling emotionally blank in moments that should matterAvoiding quiet moments because my mind becomes loud (overwhelming, worried, etc.)None of these
• Right now, I…*
  Know what’s driving this (even if I haven’t changed it yet)Have theories about why this is happening, but I’m not sure what’s trueGenuinely don’t know what’s going on anymore — I just know I can’t continue like this
• If the path forward required discomfort, I would…*
  Do it immediately. I want to change, but I don’t know how. I’m readyDo it if I had structure, accountability, and reassuranceAvoid / delay it, or negotiate it down
• In the last 14 days, I avoided at least one critical conversation/decision because of how I felt.*
  YesNo
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• What has been most true during the past 14 days?*
  I’m making smaller decisions to avoid having to face the bigger, more important onesI’m productive, but I don’t trust my judgment anymoreI’m going back and forth between being really intense and shutting downI haven’t been able to feel calm — my usual mood feels rough or shaky
• In the last 14 days, the voice in my head has been saying things like… (select the dominant one)*
  I don’t even feel like myself anymoreI’m worried someone will notice how bad things really areI keep thinking about just walking away from everythingEven when I achieve something great, I feel empty insideI’m figuring things out little by little, even if it’s slow
• Things I have already tried in my personal life that didn’t solve the real issue*
  Tried making more routines and organizing my life betterGot coaching to improve my performanceWent to therapy and talked about it (more than 3 months)Took breaks / time off (more than 7 days at once), or went on retreats to resetNothing serious yet — I’ve just been trying to work harder to get through it
• Right now, I…*
  Know what’s driving this (even if I haven’t changed it yet)Have theories about why this is happening, but I’m not sure what’s trueGenuinely don’t know what’s going on anymore — I just know I can’t continue like this
• If the path forward required discomfort, I would…*
  Do it immediately. I want to change, but I don’t know how. I’m readyDo it if I had structure, accountability, and reassuranceAvoid / delay it, or negotiate it down
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• How many of these things fell apart for you within three months: your body, your relationships, your mind / identity?*
  Just oneTwo at onceAll threeEverything fell apart all at once
• In the past 7 days, I’ve had X days when I felt genuinely stable*
  0 – 1 days2 – 3 days4+ days
• If nothing changes, I feel like my options are running out in…*
  A few weeksA few daysI can’t tell — I just need this to stop
• If I did nothing for 30 days, the most likely cost is… (select the dominant one)*
  My health (mental / physical) would get much worseMy relationship would fall apartI might make a choice that I can’t take backI’d lose motivation to improve things
• If the path forward required discomfort, I would…*
  Do it immediately. I want to change, but I don’t know how. I’m readyDo it if I had structure, accountability, and reassuranceAvoid / delay it, or negotiate it down
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• What made you finally pay attention?*
  My body and nervous system is signaling that something is wrongThere is a serious strain or breaking point in an important relationshipToo much work – I left the company to step back and sell my assetsSlow erosion happened gradually over time – it wasn’t just one single event.
• If I say the quiet part out loud…*
  I don’t know who I am without the role / companyRest doesn’t work anymoreMy life is built around performance — there’s no space for me
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• What made you finally pay attention?*
  My body and nervous system is signaling that something is wrongThere is a serious strain or breaking point in an important relationshipToo much work – I left the company to step back and sell my assetsSlow erosion happened gradually over time – it wasn’t just one single event.
• If I say the quiet part out loud…*
  I don’t know who I am without the role / companyRest doesn’t work anymoreMy life is built around performance — there’s no space for me
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• What made you finally pay attention?*
  My body and nervous system is signaling that something is wrongThere is a serious strain or breaking point in an important relationshipToo much work – I left the company to step back and sell my assetsSlow erosion happened gradually over time – it wasn’t just one single event.
• If I say the quiet part out loud…*
  I don’t know who I am without the role / companyRest doesn’t work anymoreMy life is built around performance — there’s no space for me
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• To tailor next steps, what best fits?*
  Post-exitBetween companiesUnder USD 2MUSD 2M – 6MUSD 6M – 10MUSD 10M – 25MUSD 25M – 100MUSD 100M+
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• What is your urgency window? How soon do you need to act?*
  1 – 7 days8 – 31 days1 – 3 months3+ months
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