Post Divorce Survey (Women)
Preliminary Questionnaire
Sign in to Google to save your progress. Learn more
Email *
How long were you married *
Do you have any of these traumas in your past?
How long before the divorce was filed was the relationship declining? *
What were the reasons for the relationship declining? *
Who filed for divorce? *
If you filed for divorce, what happened to cause you to commit to filing for divorce?
Have you had thoughts of suicide either before, during or after the divorce? *
If you have children, please list their ages at the time of the divorce or type NA if not applicable. *
Please describe any support system you had in place during the divorce (if any). *
How did you manage your emotions during the divorce? (coping mechanisms, therapist, friends, family, etc.) *
What were the results of this approach to managing your emotions? *
Have you experienced any health problems or weight loss/gain due to divorce? *
What responses to the divorce have you observed in your children? *
How did your family respond to the news about your divorce? *
How much detail have you shared with others about the circumstances leading up to and during the divorce? *
Do you feel like you've been able to express your emotions and feelings about the divorce to someone you trust? *
Have you lost any relationships as a result of the divorce (friends/family)? *
What sources of encouragement did you rely on during the divorce? *
Looking back, do you feel like you did everything in your power to try to save your marriage? *
Looking back, what would you do differently in your marriage? *
Looking back, what would you do different in your divorce? *
Did you and your ex-spouse participate in marriage counseling at any point during your marriage? *
Do you have any regrets from the marriage? Explain. *
Do you have any regrets from the divorce? Explain. *
What is the relationship status of your ex-spouse? (remarried, seeing someone, living w/someone, etc.) *
What's the ex-spouse's relationship like with the children now? *
Describe how your relationship with your children has been effected by the divorce. *
Are you seeing anyone at this time? *
Would you consider reconciliation with your ex-spouse?  *
What are you most triggered by now? Share as many as you'd like! *
What is your response to a trigger? Choose as many as you'd like. *
What emotions come up when you get triggered? Which do you struggle most to manage (put an asterisk) *
Who and/or what is most triggering for you? *
How long does it take for your reaction and emotions to settle down (until you feel in control again)? *
How would you rate your emotional health right now?
On a scale of 1-10 (1 being lowest).
How important is having a strong sense of emotional health, peace and joy restored to you? 
On a scale of 1-10 (1 being lowest).
What area(s) of life do you struggle the most? *
Would you like to schedule a 30 minute complimentary coaching session?

This survey is anonymous. If you'd like to schedule a session with me, please go to my website at and click on the link titled "Schedule a Discovery Call."
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy