Email Advice | Intake Form

Section 01

Who you are

Quick basics so I can address you properly and know more about your situation.

First Name

Email

Country / Timezone

Age Range (optional)

Section 02

Your situation right now

A quick snapshot so I have the right context. No essays here yet — that comes later.

Where are you in this?

Still in the relationship — and not yet ready to leave Still in the relationship — but actively planning my exit Separated — but it's not final yet Recently out — within the last 6 months Out for a while — but still struggling to feel like myself Currently dating — and seeing red flags I want to check Raised by a narcissistic parent — and seeing the patterns repeat Other — I'll explain below

How long has this been going on?

Are children involved?

Are you currently living together?

Yes — under the same roof No — but recently separated No — apart for over 6 months Not applicable to my situation

Section 03

A safety check first

This is important. Please answer honestly — I want to make sure email advice is the right help for what you're facing.

Are you currently physically safe?

Yes — I'm physically safe Mostly — but there have been incidents No — I don't feel physically safe right now

Please read this before continuing.

If you are in immediate danger, please contact emergency services right now.

Email advice dpecifically, has a 24-hour turnaround — that's not the right help if you need an answer today. Please reach out to one of these resources first:

USA: National Domestic Violence Hotline — 1-800-799-7233 or text "START" to 88788
UK: National Domestic Abuse Helpline — 0808 2000 247
Australia: 1800RESPECT — 1800 737 732
Canada: Canadian Centre for Men and Families — 1-866-481-3135

You can still submit this form — but please reach out to one of these first if you're in any danger today. I'll do my best to help with the bigger picture once you're safe.

Section 04

The full story

This is where you tell me what's actually going on. Be specific. Specific details get specific advice — vague stories get vague advice.

In your own words — what's happening?

Up to 1,000 words. Tell me what's been going on, the patterns you've noticed, specific incidents that stand out, how you've been feeling. Don't worry about writing perfectly — just tell it like you'd tell a brother.

0 / 1,000 words Tip: 500–800 words is the sweet spot

What specifically prompted you to reach out today?

Was there a specific incident? A realization? A decision you're facing? What pushed you to actually do this now, instead of waiting another month?

What have you already tried?

Therapy, books, podcasts, conversations with friends, attempts to fix the relationship — what have you done that hasn't worked yet?

Section 05

What you want from this coaching session

This is the most important question on the form. Help me know how to help you. Pick whichever apply.

What does a "useful response" look like for you?

A reality check — am I crazy or is this actually happening? A clear next step — what do I do now? Help understanding her behavior — what's actually going on? Help understanding my own reactions — why I'm responding the way I am Help with a specific decision I'm facing A tactical strategy — for kids, money, or exit planning The hard truth — even if it stings. Don't soften it.

If you could ask me one direct question, what would it be?

Optional — but if there's a specific question burning in your chest, write it here. I'll make sure I answer it.

Section 06

A few last things

Almost done. These help me tune the response to you.

How familiar are you with my work?

Is there anything else I should know?

Optional. Anything that didn't fit above — context, history, fears, things you can't say to anyone else.

— Acknowledgment

I understand this is education and coaching — not therapy, legal advice, or medical care. If I'm in crisis or need clinical support, I'll seek the right professional in addition to this. I also understand my response will arrive within 24 hours of submitting this form.

Give me everything I need to actually help.