Application for SOS Love Rescue™ Session - Aneta Mildiani

I invite you to answer a few essential questions!

Application for SOS Love Rescue™ Session

Please complete this questionnaire as thoroughly as possible before our consultation. It will give me a clear picture of your situation and help me determine whether I can genuinely assist you. I personally review every response and all information you share will remain strictly confidential.

If I see that I can help you, my assistant will contact you within few working hours to arrange your session. Please note that all scheduled times are set according to the GMT+1 time zone.

All of my other consultations are conducted via video call on the Zoom platform, but due to the urgent and specific nature of this consultation, you may also choose a phone session without video. However, based on my experience, I still recommend a video meeting, as it tends to be more effective.

If I believe that I am not the right fit for your needs, I will let you know as I do not want to waste your time or money on a session that would not bring you results.

Your answers will also allow me to gather essential background information in advance, so we do not spend valuable consultation time on basic questions. This way, we can use every minute of our time together as productively as possible. The more I know about you, the better I can prepare and make the session truly worth your investment.

Your email address:

Your phone number:

What exactly happened as the crisis event?

When did this event take place?

Have you had any contact with your partner since then?

Who initiated the current crisis?

How would you describe the current status of the relationship?

How has your partner behaved since the crisis?

How did you react immediately after the crisis? (You can choose few answers).

Since the event, have you sent messages to your partner under strong emotional pressure?

Were there any threats, ultimatums, or emotional blackmail?

Did you try to “fix the situation” with long explanations?

Do you feel that your reactions made the situation worse?

How would you assess your current emotional state?

Are you experiencing difficulty concentrating or functioning normally?

Are you experiencing suicidal thoughts?

Do you currently have emotional support, such as family or friends?

Are you willing to temporarily refrain from contact with your partner if it is necessary?

Are you able to follow instructions precisely, even if they feel counterintuitive?

Are you ready to act strategically rather than emotionally?

Do you understand that the goal of this session is stabilization, not the immediate recovery of your partner?

Are you currently undergoing psychiatric treatment or intensive psychological therapy?

Are you currently in a situation of real physical danger from your partner or another person?

Do you understand that if your situation requires medical or therapeutic intervention, the session may be refused or stopped?

How would you prefer to have the consultation?

What are your preferred contact hours (GMT+1)?

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