Un-Enmesh
Call 833-486-6374 (ENMESH1)
info@unenmesh.com
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About
Our Mission
Why We Exist
What We Believe
Results (Real Stories, Real Impact)
Who We Are
Our Philosophy
Coaching Packages
Program
The Un-Enmesh Method: A four-part journey back to your true self
What You’ll Receive
FAQs
Blog
Stories
Resources
Contact
Start Healing
Login
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X-twitter
Instagram
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Envelope
Menu
Home
About
Our Mission
Why We Exist
What We Believe
Results (Real Stories, Real Impact)
Who We Are
Our Philosophy
Coaching Packages
Program
The Un-Enmesh Method: A four-part journey back to your true self
What You’ll Receive
FAQs
Blog
Stories
Resources
Contact
Start Healing
Login
Client Intake Form
Client Intake Form
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PERSONAL INFORMATION
Layout
Name
*
Email
*
Occupation & Employer
Date of Birth
*
Phone Number
*
Address
LIVING & RELATIONSHIP CONTEXT
What type of relationship dynamic are you seeking support around?
Parent-child
Ex-partner
Friend
Roommate
Partner/Spouse
Sibling
Relative
Co-worker
Live-in partner
Step-parent or step-child
Neighbor
Other
Other
Do you currently live with this person?
Yes
No
How would you describe your emotional boundaries in this relationship?
Clear and respected
Sometimes blurred
Frequently violated or ignored
I'm unsure
Do you frequently feel guilt, anxiety, or fear when asserting independence?
Yes
Sometimes
Rarely
No
What role do you tend to play in close relationships? (Check all that apply)
People pleaser
Rescuer / fixer
Peacekeeper
Rebel
Caregiver
Emotionally dependent
Other
ENMESHMENT AWARENESS & READINESS
What made you seek coaching at this time? (Open-ended)
In 1–3 sentences, describe what enmeshment looks or feels like in your life: (Open-ended)
Please describe your life and enmeshment-related goals for the next:
3 weeks
6 weeks
9 weeks
12 weeks
Have you ever tried to separate from your enmeshed partner or parent?
Yes
No
If yes, what emotions came up and what was the result? (Open-ended)
Do you experience any emotional reactions (guilt, fear, anger, etc.) when you try to set boundaries?
Yes
No
Sometimes
Please elaborate: (Open-ended)
How ready do you feel to make a change in this dynamic?
Selected Value:
1
Scale of 1 (Not ready) to 10 (Absolutely ready):
What’s holding you back (if anything)? (Open-ended)
How would your life change if you no longer felt enmeshed with this person?
COACHING GOALS
What are 1–3 goals you want to accomplish during the 12-week program? (Open-ended)
Do you need help setting boundaries?
Yes
No
If yes, what kind of boundaries are you struggling with most?
Emotional
Physical
Time-related
Energetic
Financial
Digital
Other
Other
What would “success” look like for you at the end of this program? (Open-ended)
What support or accountability methods work best for you?
Direct and structured
Encouraging and gentle
Flexible and exploratory
Flexible and exploratory
Choice 5
What would you like your coach to do when you’re stuck or discouraged? (Open-ended)
MENTAL & EMOTIONAL HEALTH CHECK
Are you currently in therapy or working with a counselor?
Yes
No
Previously but not now
Have you been diagnosed with a mental health condition (anxiety, depression, etc.)?
Yes
No
Prefer not to say
Are you currently taking any medication for emotional or mental health reasons?
Yes
No
Do you experience any of the following regularly? (Check all that apply)
Anxiety or panic
Guilt or shame
Difficulty setting boundaries
People-pleasing
Fear of disappointing others
Chronic indecision
Emotional exhaustion / burnout
IDENTITY, VALUES & INNER VOICE
Do you feel you have a clear sense of self and personal identity?
Yes
No
Somewhat
When was the last time you did something just for you, without asking for permission or validation? (Open-ended)
What core values or personal beliefs are most important to you? (Open-ended)
Do you have support outside of your coach?
Yes
No
If yes, who is in your support circle (friends, therapist, partner, community)? (Open-ended)
Are there cultural, spiritual, or religious beliefs you'd like us to be aware of when supporting you? (Open-ended)
PRACTICAL COACHING PREFERENCES
Preferred coaching format
Video sessions
Phone calls
Messaging + voice notes
Hybrid / flexible
Best days and times for sessions/check-ins: (Open-ended)
Do you prefer weekly sessions, bi-weekly, or custom pacing? (Open-ended)
Would you like to use Voxer for voice/text support between sessions?
Yes
No
If yes, please provide your Voxer handle
Payment preference:
Pay per session
Monthly package
Pay in full
What is your budget range or comfort level with coaching investment? (Optional)
FINAL DETAILS
Is there anything else you want your coach to know before you begin? (Open-ended)
Have you previously worked with a coach or therapist? What worked / didn’t work for you? (Open-ended)
How did you hear about us?
Instagram / Social Media
Podcast / Blog
Google / Website
Other
Other
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