Application to Work w/Ryan Thomas & Get Them Back

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Helping Parents Reconnect with their Children

***WATCH THIS 1 Minute Video First - Then Fill Out This Application To Work with Ryan Thomas' Get Them Back***

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What's your name?* This field is required.

First Name

Last Name

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What title best describes you?* This field is required.Mom, Dad, Grandparent, Step-Parent, etc.

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What's your email address?* This field is required.We will use this to reply to you.

example@example.com

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What’s your phone number?* This field is required.

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What are the names and ages of your ALIENATED children?* This field is required.

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Do you have any other children that are not alienated?* This field is required.YES/NO - please list their names and ages if yes.

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Are you...* This field is required.

Divorced

In the process of getting divorced

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Are you currently involved in the legal system with a court or custody case?* This field is required.

YES

NO

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Were you referred by anyone?* This field is required.(If Yes, who? Person's Name, Youtube, Facebook, Instagram, LinkedIN, etc?)

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How long have you been rejected?* This field is required.

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How much access do you have to your child or children?* This field is required.

NONE

NONE (Legally Prohibited) - This may prevent our ability to help

Extremely Limited

Limited

Full Access

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Describe your access and what you can and can not do....* This field is required.

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Who is alienating your child from you?* This field is required.Other Parent, Grandparent, Son-in-Law, Daughter-in-Law, etc.

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What are the top 3 core challenges you want to fix?* This field is required.

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What do you feel you need to do better? (please be as detailed as possible)* This field is required.

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Briefly share your story with only the most important details.* This field is required.

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What do you want your relationship to look like 12 months from now?* This field is required.

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Which solutions have you tried? (Select all that apply)* This field is required.

Books

Online Courses

Workshops

Reunification Therapy

Counseling

Legal/Court System

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How much have you spent trying to resolve this?* This field is required.

$1,000-$10,000

$10,000-$50,000

$50,000-$100,000

$100,000+

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Why do you think those "solutions" haven't solved the problem yet?

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How has being rejected effected you? (Select all that apply)* This field is required.

Stress & Anxiety

Feeling lonely & isolated

Trouble Sleeping

Health Issues

Frustration & Anger

Strain on other relationships

Impact on Job Performance

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Based on your situation, what are your biggest fears? (Select all that apply)* This field is required.

I’ll never see my child again

Everyone will turn against me

I will fall into a spiral of sadness and depression

I’ll miss out on sharing a life with them

My child will think I am bad or evil

My efforts will be seen as me “buying their love”

My child won't know how much I love them

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What issues do you struggle with emotionally because of all this, and how does it affect your mindset?

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What will you miss out on in your child’s life if you don’t rebuild the relationship?* This field is required.

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What do you think will happen to your child if YOU are not in their life and they are only influenced by the other parent?* This field is required.

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What do you think your relationship will look like in 3 years of nothing changes? ** This field is required.

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What excites you about working with us?* This field is required.

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How soon are you looking to work with us, if it's a good fit?* This field is required.

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We have select enrollment periods throughout the year. Which enrollment period are you interested in?

February 6, 2023

September 2023

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Why do you think you would be a good client?* This field is required.

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Is there anything else we should know?* This field is required.

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To get to know you better, what type of work do you do?* This field is required.

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Finally, describe yourself when you are at your BEST.* This field is required.

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