Full Name

Email *

Phone *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Captcha

Have you ever been a victim of narcissistic or abusive behavior? *

Yes, I have had an abusive/narcissistic partner

Yes, I have have had an abusive/narcissistic family member

I am not sure if I have had an abusive/narcissistic relationship

I have not been the victim of an abusive/narcissistic relationship

Do you suffer from any of these medical issues? (Check all that apply) *

Depression

Anxiety

Post Traumatic Stress Disorder

None of These

Do you feel you are confident in yourself? *

Yes, I generally like who I am.

There are some things I would change about myself, but I still feel confident in myself.

I do not feel very confident in who I am most of the time.

I do not like myself at all.

Do you often avoid conflict? *

• Yes, I try to avoid conflict as much as possible
• Sometimes I avoid conflict to "keep the peace"
• No. I am not afraid of conflict.
• No elements found. Consider changing the search query.
• List is empty.

How do you feel when someone crosses your boundaries? (Check all that apply) *

Disrespected or invalidated

Anxious or uncomfortable

Angry or frustrated

Unsure or confused

It doesn’t bother me

Do you feel like you can express those feelings in a healthy way? (Check all that apply) *

Yes, I feel like I am able to communicate my feelings well.

I tend to hold my feelings in. Sometimes they come out in other ways in my relationships.

Communicating my feelings makes me feel uncomfortable.

Sometimes I mask my hurt with anger or sarcasm.

I am often too afraid to share my feelings. Sometimes it causes me to be taken advantage of.

I can say "No" when I need to. *

I have no issue saying "no" when necessary.

Most of the time I feel comfortable saying "No" when I need to.

I can say "No" sometimes, but it makes me very uncomfortable.

I struggle to say "No" even when I know I should.

I apologize too much, even when I'm not at fault. *

• True
• Sometimes
• False
• No elements found. Consider changing the search query.
• List is empty.

I tend to put others' needs above my own *

• Yes, I tend to put the needs of others above my own.
• Sometimes. I try to balance my needs with the needs of others.
• Never. I always put my needs first.
• No elements found. Consider changing the search query.
• List is empty.

NEXT