Name

First Name

Last Name

Would you like to remain anonymous?

Yes

Preferred Name (if you choose to remain anonymous)

First Name

Last Name

Briefly describe your current family structure:

e.g., married with children, single parent, blended family, etc.

Who are the key people involved in the conflict or dynamics you’d like to discuss?

Include ages and relationships, if applicable

What is the main family conflict or dysfunctional dynamic you’re experiencing?

Please be as specific as you feel comfortable

How long has this been an issue for you?

What have you tried in the past to address or resolve this issue?

Include any counseling, strategies, or conversations

How does this conflict make you feel?

List any emotions you experience regularly, e.g., anxious, sad, angry, hopeless

What are your biggest fears regarding this conflict?

What are your deepest hopes for resolution or healing?

How has your faith or spiritual journey influenced the way you view or handle this conflict?

For example, are there specific beliefs that have helped you find strength, or perhaps some that have made things more challenging?

Are you comfortable with me incorporating faith-based principles and biblical counseling into our session?

Yes

Have you experienced similar conflicts or struggles in the past? If so, how did those situations affect you, and do you notice any patterns or recurring themes in how you handle conflict?

What do you believe about yourself, your worth, or your role in your family? How might these beliefs be influencing your current conflict or situation?

Do you struggle with feeling responsible for other people’s happiness or well-being? How does this impact your actions and emotions?

Have you taken the ‘Discover Your Go-To Position’ quiz on the Unhappy Kid Triangle?

Yes

If yes, which role(s) do you most identify with?

Helpless Baby

Bossy Helper

Blaming Bully

What do you hope to gain from this session?

e.g., clarity, practical steps, emotional healing, a better understanding of the conflict

Are there specific areas you’d like me to focus on?

e.g., setting boundaries, understanding your emotions, finding healing

Are there any topics or areas you’d prefer not to discuss in depth?

Please list any known triggers or sensitive subjects

How do you typically respond when discussing difficult topics?

e.g., shutting down, getting emotional, feeling defensive, anxiety

What can I do to help you feel safe and comfortable during our session?

e.g., gentle approach, reassurance, breaks if needed

Do you have any concerns or questions about the session format or the podcast recording?

Do you have any time constraints for the session?

Please let me know if we need to stay within a specific time frame

Is there anything else you’d like me to know before our session?

This could be additional background information, concerns, or hopes

How do you usually react when you feel misunderstood, disrespected, or hurt?

e.g., withdrawing, getting defensive, trying to fix the situation

What emotions are most difficult for you to express or deal with, and why?

Do you feel a sense of obligation to keep the peace or avoid conflict at all costs? How has this affected your relationships over time?

Are there any unspoken rules or expectations in your family that you feel pressured to follow? What are they, and how do they impact you?

What would a restored and healed relationship look like to you? What would need to change for this to happen?

If you could break free from one fear or limitation related to this conflict, what would it be?

How do you feel God has been present or absent in your struggles? Have you had any moments where you felt particularly close to or distant from Him?

What spiritual practices or beliefs bring you comfort, even in the midst of conflict?

Disclaimer and Consent

Please read the following carefully and select "I agree" to indicate your understanding and agreement: 1. I understand that this on-air session is for faith-based, biblical counseling and coaching purposes only. It is not a substitute for professional therapy, medical advice, or legal counsel. 2. I acknowledge that Danielle Alvarez Greer is a biblical counselor and family coach, not a licensed therapist or medical professional. 3. I understand that sharing my story and experiences on The Happy Family Coach Podcast may have an impact on listeners, but Danielle Alvarez Greer and The Happy Family Coach are not responsible for any emotional or relational outcomes resulting from participating in or listening to this session. 4. I voluntarily agree to participate in this session and understand that I can choose to remain anonymous. I accept any potential emotional or relational risks involved. 5. I consent to having this session recorded and potentially edited for the podcast, understanding that I can withdraw my consent at any time before the recording is published.

Client Forms

On-Air Happy Family Coach Podcast Intake Form

Thank You for Sharing Your Heart!

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