CONNECT

Name

Full name not required.

First Name

Last Name

Age

18-25

25-35

35-45

50+

Gender

FEMALE

MALE

NON-BINARY

If yes, is your narcissistic relationship with a:

Significant Other

Family Member

Friend

Co-worker

Boss

Parent

Are you currently going through separation or divorce?

Yes

No

Are you currently receiving mental health treatment?

Yes

No

Are you currently still maintaining a relationship with a narcissist in your life?

Yes

No

Unsure

Have you been away from your narcissist for more than 3 months?

Yes

No

Have you recently separated or gone no-contact with your narcissist?

Yes

No

Would you be inclined to feel most comfortable with strictly virtual participation or would you prefer in-person?

Virtual

In-Person

Individual Counseling

Support Group Sessions