Gentlemen’s Connection CodeIntake Form

What stage of divorce or separation are you currently in?*

How long has this transition been impacting your life?*

What has been the hardest part of rebuilding your identity as a man?*

How would you describe your current emotional presence?*

What emotional patterns do you notice in yourself (withdrawal, anger, shutdown, over‑giving, etc*

What emotions do you struggle to express clearly?*

What challenges do you face when trying to connect with others?*

What do you want to improve in your communication or relational presence?*

What feels missing in your relationships right now?*

Where do you feel your masculine leadership is strongest?*

Where do you feel it’s weakest?*

What version of yourself are you trying to rebuild?*

What is the #1 outcome you want from coaching?*

What would make this program a powerful win for you?*

What do you want to accomplish in the next 90 days?*

Are you willing to complete weekly assignments?*

Are you willing to be challenged and held accountable?*

Are you ready to invest time, energy, and focus into your growth?*

What is your availability for coaching calls?*

What is your preferred communication method ?*

Anything else you want me to know before our session?