Bridging the Gap Emotional Support Program Pre-Assessment Form
Thank you for your interest in the Bridging the Gap: Hurting to Healing Emotional Support Program! This pre-assessment form was designed to maximize the 30-minute consultation with the Founder of Matters of My Heart, LLC. Please complete the form, at which time you will access to schedule your FREE 30-minute consultation. If you have any questions, please send an email to I look forward to serving you.

**Please note that the information provided in this assessment is kept confidential and only viewed by the Founder of Matters of My Heart, LLC.

Email address *
Full Name *
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Marital Status
Do you have any children? If so, how many?
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Mailing Address
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Best contact phone number *
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