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Mini Self Assessment
Take this self assessment to schedule your free strategy call with a Divorce Specialist.
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Your Name
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Email
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This is required to schedule a call with a Divorce Specialist.
example@example.com
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Phone Number
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Are you a:
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Mom
Dad
Neither
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6
What is your status?
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Contemplating divorce
Separated
Divorced
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7
What experience do you have with divorce?
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My parents had an amicable divorce
My parents had a nasty divorce
I have heard horror stories from friends & family
None
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8
Have you tried mediation?
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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
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9
How old are you?
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How many children do you have?
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How old are your children?
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12
How did you hear about us?
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I was referred to you by:
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Which country do you live in?
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USA
Canada
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Specify which country
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Select your province:
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Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
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Please Select
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
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17
original Your province:
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province text
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Select the state you live in:
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20
Specify your County, Town or City
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21
Tell us briefly how you feel right now
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22
Do you have a support system?
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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
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23
Support system - Other?
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24
Myself
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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
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25
Myself - Other
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26
Kids
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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
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27
Kids - Other
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28
My Mindset
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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
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29
My Mindset - Other
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30
How are you feeling right now?
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Select all that apply:
😄 Happy
😢 Sad
😠 Angry
😟 Anxious
😌 Content
😎 Confident
😌 Relieved
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31
How do you want to be feeling in 3-6 months?
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Select all that apply:
😄 Happy
😢 Sad
😠 Angry
😟 Anxious
😌 Content
😎 Confident
😌 Relieved
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32
Finances
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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
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33
Finances - Other
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34
Spiritual
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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
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35
Spiritual - Other
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36
Career
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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
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37
Career - Other
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Kindly share more details with us
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38
Are you a stay at home Mom or Dad?
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We are delighted to have various options and tailor-made services to ensure you remain aligned with your needs
YES
NO
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39
If you are a stay at home Mom or Dad with no income, what is your family income?
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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 +
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40
What is your personal income bracket?
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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+
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41
What is your Occupation?
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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
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42
Would you like free resources?
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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
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43
Who would you like referrals to professionals in your region?
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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
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44
How would you like us to send you the information?
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Send it via email
Send it via text message
Other
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45
Schedule your free strategy call with a Divorce Specialist to discuss your challenges and requirements in more detail
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** 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
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46
Would you like to share anything else with us?
Including your worries, concerns or questions. We are here for YOU!
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