{"id":1273,"date":"2025-11-03T05:55:36","date_gmt":"2025-11-03T05:55:36","guid":{"rendered":"https:\/\/myselfsabotagecoaching.com\/?page_id=1273"},"modified":"2025-11-03T06:32:19","modified_gmt":"2025-11-03T06:32:19","slug":"report-form2","status":"publish","type":"page","link":"https:\/\/myselfsabotagecoaching.com\/index.php\/report-form2\/","title":{"rendered":"Report-Form2"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1273\" class=\"elementor elementor-1273\">\n\t\t\t\t<div class=\"elementor-element elementor-element-29f4cce e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"29f4cce\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6a44e29 elementor-widget elementor-widget-wpforms\" data-id=\"6a44e29\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-1260\"><form id=\"wpforms-form-1260\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1260\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/1273\" data-token=\"75c44cbe44ce2e479cb9bda5f33b11d5\" data-token-time=\"1776848455\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-1260-field_8-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"8\"><fieldset><legend class=\"wpforms-field-label\">How long were you with your ex? *<\/legend><ul id=\"wpforms-1260-field_8\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1260-field_8_1\" name=\"wpforms[fields][8]\" value=\"Less than 5 years\" aria-errormessage=\"wpforms-1260-field_8_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1260-field_8_1\">Less than 5 years<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1260-field_8_2\" name=\"wpforms[fields][8]\" value=\"More than 5 years\" aria-errormessage=\"wpforms-1260-field_8_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1260-field_8_2\">More than 5 years<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1260-field_9-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"9\"><fieldset><legend class=\"wpforms-field-label\">When did you break up? *<\/legend><ul id=\"wpforms-1260-field_9\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1260-field_9_1\" name=\"wpforms[fields][9]\" value=\"In the last 3 months\" aria-errormessage=\"wpforms-1260-field_9_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1260-field_9_1\">In the last 3 months<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1260-field_9_2\" name=\"wpforms[fields][9]\" value=\"About 6 months ago\" aria-errormessage=\"wpforms-1260-field_9_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1260-field_9_2\">About 6 months ago<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1260-field_9_3\" name=\"wpforms[fields][9]\" value=\"About 1 year ago\" aria-errormessage=\"wpforms-1260-field_9_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1260-field_9_3\">About 1 year ago<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1260-field_10-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"10\"><fieldset><legend class=\"wpforms-field-label\">What do you want help with? *<\/legend><ul id=\"wpforms-1260-field_10\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1260-field_10_1\" name=\"wpforms[fields][10]\" value=\"Saving the relationship\" aria-errormessage=\"wpforms-1260-field_10_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1260-field_10_1\">Saving the relationship<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1260-field_10_2\" name=\"wpforms[fields][10]\" value=\"Moving on with my life\" aria-errormessage=\"wpforms-1260-field_10_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1260-field_10_2\">Moving on with my life<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1260-field_10_3\" name=\"wpforms[fields][10]\" value=\"Not sure, I just want the pain to end\" aria-errormessage=\"wpforms-1260-field_10_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1260-field_10_3\">Not sure, I just want the pain to end<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1260-field_11-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-1260-field_11\">With complete honesty, why did you guys break up? Why did she leave? *<\/label><textarea id=\"wpforms-1260-field_11\" class=\"wpforms-field-medium\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-1260-field_11-error\" ><\/textarea><\/div><div id=\"wpforms-1260-field_15-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-1260-field_15\">What\u2019s the hardest part about the break up? (Paint me a picture of what&#039;s going on in your life and help me understand your situation) *<\/label><textarea id=\"wpforms-1260-field_15\" class=\"wpforms-field-medium\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-1260-field_15-error\" ><\/textarea><\/div><div id=\"wpforms-1260-field_16-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"16\"><fieldset><legend class=\"wpforms-field-label\">Which best describes you? *<\/legend><ul id=\"wpforms-1260-field_16\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1260-field_16_1\" name=\"wpforms[fields][16]\" value=\"Not sure I want to do anything about the break up right now\" aria-errormessage=\"wpforms-1260-field_16_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1260-field_16_1\">Not sure I want to do anything about the break up right now<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1260-field_16_2\" name=\"wpforms[fields][16]\" value=\"I know I need to make a change in my life, not sure what to do but I reckon I will be able to figure it out eventually\" aria-errormessage=\"wpforms-1260-field_16_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1260-field_16_2\">I know I need to make a change in my life, not sure what to do but I reckon I will be able to figure it out eventually<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1260-field_16_3\" name=\"wpforms[fields][16]\" value=\"Iv&#039;e had enough of feeling this way. Im 100% all in to get expert advice and coaching. I will commit all my time, attention and energy into improving my situation, whatever it takes as long as it works\" aria-errormessage=\"wpforms-1260-field_16_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1260-field_16_3\">Iv'e had enough of feeling this way. Im 100% all in to get expert advice and coaching. I will commit all my time, attention and energy into improving my situation, whatever it takes as long as it works<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1260-field_17-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-1260-field_17\">What do you do for work? (If not working please dont book. Keeping a roof over your head, food on the table and being able to financially sustain your life MUST be your main priority before anything) *<\/label><textarea id=\"wpforms-1260-field_17\" class=\"wpforms-field-medium\" name=\"wpforms[fields][17]\" aria-errormessage=\"wpforms-1260-field_17-error\" ><\/textarea><\/div>\t\t<div id=\"wpforms-1260-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-1260-field_1\" >about book. financially<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-1260-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-1260-field_19-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-1260-field_19\">First Name<\/label><input type=\"text\" id=\"wpforms-1260-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\" aria-errormessage=\"wpforms-1260-field_19-error\" ><\/div><div id=\"wpforms-1260-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-1260-field_18\">Last Name<\/label><input type=\"text\" id=\"wpforms-1260-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-1260-field_18-error\" ><\/div><div id=\"wpforms-1260-field_21-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-1260-field_21\">Mobile<\/label><input type=\"number\" id=\"wpforms-1260-field_21\" class=\"wpforms-field-medium\" name=\"wpforms[fields][21]\" step=\"any\" aria-errormessage=\"wpforms-1260-field_21-error\" ><\/div><div id=\"wpforms-1260-field_22-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-1260-field_22\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1260-field_22\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][22]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1260-field_22-error\" required><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-1260-field_1-container { position: absolute !important; 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How long were you with your ex? * Less than 5 years More than 5 years When did you break up? * In the last 3 months About 6 months ago About 1 year ago What do you want help with? * Saving the relationship Moving on with my life Not sure, I just want the pain to end With complete honesty, why did you guys break up? Why did she leave? *What\u2019s the hardest part about the break up? (Paint me a picture of what&#039;s going on in your life and help me understand your situation) * Which best describes you? * Not sure I want to do anything about the break up right now I know I need to make a change in my life, not sure what to do but I reckon I will be able to figure it out eventually Iv&#8217;e had enough of feeling this way. Im 100% all in to get expert advice and coaching. I will commit all my time, attention and energy into improving my situation, whatever it takes as long as it works What do you do for work? (If not working please dont book. Keeping a roof over your head, food on the table and being able to financially sustain your life MUST be your main priority before anything) *First NameLast NameMobileEmail * Submit<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"ocean_post_layout":"","ocean_both_sidebars_style":"","ocean_both_sidebars_content_width":0,"ocean_both_sidebars_sidebars_width":0,"ocean_sidebar":"","ocean_second_sidebar":"","ocean_disable_margins":"enable","ocean_add_body_class":"","ocean_shortcode_before_top_bar":"","ocean_shortcode_after_top_bar":"","ocean_shortcode_before_header":"","ocean_shortcode_after_header":"","ocean_has_shortcode":"","ocean_shortcode_after_title":"","ocean_shortcode_before_footer_widgets":"","ocean_shortcode_after_footer_widgets":"","ocean_shortcode_before_footer_bottom":"","ocean_shortcode_after_footer_bottom":"","ocean_display_top_bar":"default","ocean_display_header":"default","ocean_header_style":"","ocean_center_header_left_menu":"","ocean_custom_header_template":"","ocean_custom_logo":0,"ocean_custom_retina_logo":0,"ocean_custom_logo_max_width":0,"ocean_custom_logo_tablet_max_width":0,"ocean_custom_logo_mobile_max_width":0,"ocean_custom_logo_max_height":0,"ocean_custom_logo_tablet_max_height":0,"ocean_custom_logo_mobile_max_height":0,"ocean_header_custom_menu":"","ocean_menu_typo_font_family":"","ocean_menu_typo_font_subset":"","ocean_menu_typo_font_size":0,"ocean_menu_typo_font_size_tablet":0,"ocean_menu_typo_font_size_mobile":0,"ocean_menu_typo_font_size_unit":"px","ocean_menu_typo_font_weight":"","ocean_menu_typo_font_weight_tablet":"","ocean_menu_typo_font_weight_mobile":"","ocean_menu_typo_transform":"","ocean_menu_typo_transform_tablet":"","ocean_menu_typo_transform_mobile":"","ocean_menu_typo_line_height":0,"ocean_menu_typo_line_height_tablet":0,"ocean_menu_typo_line_height_mobile":0,"ocean_menu_typo_line_height_unit":"","ocean_menu_typo_spacing":0,"ocean_menu_typo_spacing_tablet":0,"ocean_menu_typo_spacing_mobile":0,"ocean_menu_typo_spacing_unit":"","ocean_menu_link_color":"","ocean_menu_link_color_hover":"","ocean_menu_link_color_active":"","ocean_menu_link_background":"","ocean_menu_link_hover_background":"","ocean_menu_link_active_background":"","ocean_menu_social_links_bg":"","ocean_menu_social_hover_links_bg":"","ocean_menu_social_links_color":"","ocean_menu_social_hover_links_color":"","ocean_disable_title":"default","ocean_disable_heading":"default","ocean_post_title":"","ocean_post_subheading":"","ocean_post_title_style":"","ocean_post_title_background_color":"","ocean_post_title_background":0,"ocean_post_title_bg_image_position":"","ocean_post_title_bg_image_attachment":"","ocean_post_title_bg_image_repeat":"","ocean_post_title_bg_image_size":"","ocean_post_title_height":0,"ocean_post_title_bg_overlay":0.5,"ocean_post_title_bg_overlay_color":"","ocean_disable_breadcrumbs":"default","ocean_breadcrumbs_color":"","ocean_breadcrumbs_separator_color":"","ocean_breadcrumbs_links_color":"","ocean_breadcrumbs_links_hover_color":"","ocean_display_footer_widgets":"default","ocean_display_footer_bottom":"default","ocean_custom_footer_template":"","footnotes":""},"class_list":["post-1273","page","type-page","status-publish","hentry","entry"],"_links":{"self":[{"href":"https:\/\/myselfsabotagecoaching.com\/index.php\/wp-json\/wp\/v2\/pages\/1273","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myselfsabotagecoaching.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/myselfsabotagecoaching.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/myselfsabotagecoaching.com\/index.php\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/myselfsabotagecoaching.com\/index.php\/wp-json\/wp\/v2\/comments?post=1273"}],"version-history":[{"count":7,"href":"https:\/\/myselfsabotagecoaching.com\/index.php\/wp-json\/wp\/v2\/pages\/1273\/revisions"}],"predecessor-version":[{"id":1293,"href":"https:\/\/myselfsabotagecoaching.com\/index.php\/wp-json\/wp\/v2\/pages\/1273\/revisions\/1293"}],"wp:attachment":[{"href":"https:\/\/myselfsabotagecoaching.com\/index.php\/wp-json\/wp\/v2\/media?parent=1273"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}