Full Name

Email *

Phone *

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How did you hear about us? *

• TikTok
• Facebook/Instagram
• Google Search
• Heard about it from a friend
• Other
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Captcha

Does your loved one seem more withdrawn lately? *

Yes

I'm not sure

No

Does your loved one avoid making plans more when they are with their partner? *

Yes, my loved one often breaks plans when their partner is involved.

My loved one sometimes breaks plans when their partner is involved.

My loved ones breaks plans every once in a while, but I don't think it's a problem.

Does your loved one need to stay constantly connected with their partner even when they are spending time with you? *

• Yes, my loved one constantly needs to stay connected to their partner even when we are hanging out.
• My loved one often connects with their partner when we are hanging out. Sometimes it makes me feel uncomfortable.
• My loved one checks in with their partner, but it doesn't seem excessive.
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Have you noticed that your loved one has stopped sharing details about their relationship? *

Yes, I have noticed that my loved one has stopped sharing with me.

My loved one doesn't share as much as they used to.

My loved one is very open about their relationship and their partner.

Does your loved one make excuses for their partner's bad behavior? *

Yes, my loved one often makes excuses for the way their partner treats them.

Sometimes my loved one makes excuses for their partner's behavior.

No. My loved one never makes excuses for their loved one's behavior.

Has your loved one expressed any of the following to you? (Click all that apply) *

Questioning their own reality or confused about details.

Depression related to their relationship.

Anxiety about making choices without their partner.

Easy to shut down and become withdrawn.

Quick to defend or become angry when their partner's behaviors are criticized.

None of these

Does your loved one have any of these personality traits? (Click all that apply)

Deeply Empathetic

Often helps others

Has difficulty making or holding boundaries

Has fear of abandonment or past relationship trauma

Struggles to recognize their self-worth

Do you believe your loved one seems genuinely happy and emotionally safe in their relationship? *

• Yes! I believe my loved one is genuinely happy and safe in their relationship.
• I'm not sure if my loved one is happy and safe in their relationship.
• No. I do not believe that my loved one is in a happy and safe relationship.
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