General Information

First Name* @if(isset($formObj['customs']['client_fname'])) {{$formObj['customs']['client_fname']}} @else @endif

Last Name @if(isset($formObj['customs']['client_lname'])) {{$formObj['customs']['client_lname']}} @else @endif

Contact Information

Preferred Name / Nickname @if(isset($formObj['contact_info']['nick_name'])) {{$formObj['contact_info']['nick_name']}} @else @endif
Date of Birth* @if(isset($formObj['customs']['dob']) && !empty($formObj['customs']['dob'])) {{date('m/d/Y',strtotime($formObj['customs']['dob']))}} @else MM/DD/YYYY @endif	Phone* @if(isset($formObj['customs']['phone']) && !empty($formObj['customs']['phone'])) {{phoneFormat($formObj['customs']['phone'])}} @else (xxx) xxx-xxxx @endif	Email* @if(isset($formObj['customs']['email'])) {{$formObj['customs']['email']}} @else @endif

Preferred Contact Method: @if(isset($formObj['contact_info']['preferred_contact_method']) && in_array('1',$formObj['contact_info']['preferred_contact_method'])) @else @endif Call @if(isset($formObj['contact_info']['preferred_contact_method']) && in_array('2',$formObj['contact_info']['preferred_contact_method'])) @else @endif Text @if(isset($formObj['contact_info']['preferred_contact_method']) && in_array('3',$formObj['contact_info']['preferred_contact_method'])) @else @endif Email		Street Address* @if(isset($formObj['contact_info']['street_address'])) {{$formObj['contact_info']['street_address']}} @else @endif	Address Line 2 @if(isset($formObj['contact_info']['address_line_2'])) {{$formObj['contact_info']['address_line_2']}} @else @endif
City* @if(isset($formObj['contact_info']['city'])) {{$formObj['contact_info']['city']}} @else @endif	State / Province / Region* @if(isset($formObj['contact_info']['state'])) {{$formObj['contact_info']['state']}} @else @endif	Postal / Zip Code* @if(isset($formObj['contact_info']['zip_code'])) {{zipFormat($formObj['contact_info']['zip_code'])}} @else @endif	Country* @if(isset($formObj['contact_info']['country'])) {{$formObj['contact_info']['country']}} @else @endif

Marital Status* @foreach(MARITAL_STATUS_ARR as $status) @if(isset($formObj['groups']['1']) && $formObj['groups']['1']==$status['value']) @else @endif {!! $status['label'] !!} @endforeach	Other Marital Status (if applicable) @if(isset($formObj['groups']['2'])) {{$formObj['groups']['2']}} @else @endif	Number of Marriages @if(isset($formObj['groups']['3'])) {{$formObj['groups']['3']}} @else @endif
@if(isset($formObj['groups']['4']) && !empty($formObj['groups']['4'])) @else @endif Children Names & ages (if applicable) {!! nl2br($formObj['groups']['4']) !!} Child 1 - age Child 2 - age Child 3 - age
Occupation / Current Work @if(isset($formObj['groups']['5'])) {{$formObj['groups']['5']}} @else @endif

Emergency Contact

Name* @if(isset($formObj['contact_info']['emergency_contact_name'])) {{$formObj['contact_info']['emergency_contact_name']}} @else @endif

Relationship* @if(isset($formObj['contact_info']['emergency_contact_relation'])) {{$formObj['contact_info']['emergency_contact_relation']}} @else @endif

Phone* @if(isset($formObj['contact_info']['emergency_contact_phone']) && !empty($formObj['contact_info']['emergency_contact_phone'])) {{phoneFormat($formObj['contact_info']['emergency_contact_phone'])}} @else (xxx) xxx-xxxx @endif

@if(isset($formObj['groups']['6']) && !empty($formObj['groups']['6'])) @else @endif What are some current challenges or struggles you’re facing? {!! nl2br($formObj['groups']['6']) !!} What are some current challenges or struggles?	@if(isset($formObj['groups']['7']) && !empty($formObj['groups']['7'])) @else @endif What is a strength or positive quality you see in yourself? {!! nl2br($formObj['groups']['7']) !!} What is a strength or positive quality you see in yourself?
Do you have safe, supportive relationships right now? @foreach([...YES_NO_ARR, ['value' => '2', 'label' => 'Unsure']] as $status) @if(isset($formObj['groups']['8']) && $formObj['groups']['8']==$status['value']) @else @endif {!! $status['label'] !!} @endforeach
Are you currently working with a therapist, counselor, or other coach? @foreach(YES_NO_ARR as $status) @if(isset($formObj['groups']['9']) && $formObj['groups']['9']==$status['value']) @else @endif {!! $status['label'] !!} @endforeach	@if(isset($formObj['groups']['10']) && !empty($formObj['groups']['10'])) @else @endif If yes, please describe the type of counseling you are receiving {!! nl2br($formObj['groups']['10']) !!} Type of counseling you are receiving
How important is religion to you? @foreach($dataArr11 as $status) @if(isset($formObj['groups']['11']) && $formObj['groups']['11']==$status['value']) @else @endif {!! $status['label'] !!} @endforeach	To what extent do you desire to include your religious preferences in your coaching experience? @foreach($dataArr12 as $status) @if(isset($formObj['groups']['12']) && $formObj['groups']['12']==$status['value']) @else @endif {!! $status['label'] !!} @endforeach
@if(isset($formObj['groups']['13']) && !empty($formObj['groups']['13'])) @else @endif What do you hope to gain or change through this process? {!! nl2br($formObj['groups']['13']) !!} What do you hope to gain or change through this process?	@if(isset($formObj['groups']['14']) && !empty($formObj['groups']['14'])) @else @endif Are there specific patterns, habits, or emotions you’d like to understand better? {!! nl2br($formObj['groups']['14']) !!} Are there specific patterns, habits, or emotions you’d like to understand better?
@if(isset($formObj['groups']['15']) && !empty($formObj['groups']['15'])) @else @endif Story work can bring up strong emotions. Is there anything your coach should know to help keep our sessions emotionally safe for you? {!! nl2br($formObj['groups']['15']) !!} Is there anything your coach should know to help keep our sessions emotionally safe for you?
Do you have any current risk of self-harm or harm to others? @foreach(YES_NO_ARR as $status) @if(isset($formObj['groups']['16']) && $formObj['groups']['16']==$status['value']) @else @endif {!! $status['label'] !!} @endforeach	@if(isset($formObj['groups']['17']) && !empty($formObj['groups']['17'])) @else @endif If yes, please describe so we can ensure proper support. {!! nl2br($formObj['groups']['17']) !!} If yes, please describe so we can ensure proper support.

@if(isset($formMetaObj['meta']['OUR_AGREEMENT_TITLE']))

{!! $formMetaObj['meta']['OUR_AGREEMENT_TITLE'] !!}

@endif @if(isset($formMetaObj['meta']['OUR_AGREEMENT_BULLETS']) && is_array($formMetaObj['meta']['OUR_AGREEMENT_BULLETS']) && count($formMetaObj['meta']['OUR_AGREEMENT_BULLETS']) > 0)

@foreach($formMetaObj['meta']['OUR_AGREEMENT_BULLETS'] as $bullet)
• {!! $bullet !!}
@endforeach

@endif

Information for Clients

@if(isset($formMetaObj['meta']['AGREEMENT_1_TITLE']) && isset($formMetaObj['meta']['AGREEMENT_1_CONTENT']))

{!! $formMetaObj['meta']['AGREEMENT_1_TITLE'] !!}

{!! $formMetaObj['meta']['AGREEMENT_1_CONTENT'] !!}

@endif @if(isset($formMetaObj['meta']['AGREEMENT_2_TITLE']) && isset($formMetaObj['meta']['AGREEMENT_2_CONTENT']))

{!! $formMetaObj['meta']['AGREEMENT_2_TITLE'] !!}

{!! $formMetaObj['meta']['AGREEMENT_2_CONTENT'] !!}

@endif @if(isset($formMetaObj['meta']['AGREEMENT_3_TITLE']) && isset($formMetaObj['meta']['AGREEMENT_3_CONTENT']))

{!! $formMetaObj['meta']['AGREEMENT_3_TITLE'] !!}

{!! $formMetaObj['meta']['AGREEMENT_3_CONTENT'] !!}

@endif @if(isset($formMetaObj['meta']['AGREEMENT_4_TITLE']) && isset($formMetaObj['meta']['AGREEMENT_4_CONTENT']))

{!! $formMetaObj['meta']['AGREEMENT_4_TITLE'] !!}

{!! $formMetaObj['meta']['AGREEMENT_4_CONTENT'] !!}

@endif @if(isset($formMetaObj['meta']['AGREEMENT_5_TITLE']))

{!! $formMetaObj['meta']['AGREEMENT_5_TITLE'] !!}

@if(isset($formMetaObj['meta']['AGREEMENT_5_CONTENT']))

{!! $formMetaObj['meta']['AGREEMENT_5_CONTENT'] !!}

@endif @if(isset($formMetaObj['meta']['AGREEMENT_5_BULLETS']) && is_array($formMetaObj['meta']['AGREEMENT_5_BULLETS']) && count($formMetaObj['meta']['AGREEMENT_5_BULLETS']) > 0)

@foreach($formMetaObj['meta']['AGREEMENT_5_BULLETS'] as $bullet)
• {!! $bullet !!}
@endforeach

@endif @if(isset($formMetaObj['meta']['AGREEMENT_5_CONTENT_1']))

{!! $formMetaObj['meta']['AGREEMENT_5_CONTENT_1'] !!}

@endif @endif @if(isset($formMetaObj['meta']['AGREEMENT_6_TITLE']) && isset($formMetaObj['meta']['AGREEMENT_6_BULLETS']) && is_array($formMetaObj['meta']['AGREEMENT_6_BULLETS']) && count($formMetaObj['meta']['AGREEMENT_6_BULLETS']) > 0)

{!! $formMetaObj['meta']['AGREEMENT_6_TITLE'] !!}

@foreach($formMetaObj['meta']['AGREEMENT_6_BULLETS'] as $bullet)
• {!! $bullet !!}
@endforeach

@endif @if(isset($formMetaObj['meta']['AGREEMENT_7_TITLE']) && isset($formMetaObj['meta']['AGREEMENT_7_CONTENT']))

{!! $formMetaObj['meta']['AGREEMENT_7_TITLE'] !!}

{!! $formMetaObj['meta']['AGREEMENT_7_CONTENT'] !!}

@endif @if(isset($formMetaObj['meta']['AGREEMENT_8_TITLE']) && isset($formMetaObj['meta']['AGREEMENT_8_CONTENT']))

{!! $formMetaObj['meta']['AGREEMENT_8_TITLE'] !!}

{!! $formMetaObj['meta']['AGREEMENT_8_CONTENT'] !!}

@endif @if(isset($formMetaObj['meta']['AGREEMENT_9_TITLE']) && isset($formMetaObj['meta']['AGREEMENT_9_BULLETS']) && is_array($formMetaObj['meta']['AGREEMENT_9_BULLETS']) && count($formMetaObj['meta']['AGREEMENT_9_BULLETS']) > 0)

{!! $formMetaObj['meta']['AGREEMENT_9_TITLE'] !!}

@foreach($formMetaObj['meta']['AGREEMENT_9_BULLETS'] as $bullet)
• {!! $bullet !!}
@endforeach

@endif @if(isset($formMetaObj['meta']['AGREEMENT_10_TITLE']))

{!! $formMetaObj['meta']['AGREEMENT_10_TITLE'] !!}

@if(isset($formMetaObj['meta']['AGREEMENT_10_CONTENT']))

{!! $formMetaObj['meta']['AGREEMENT_10_CONTENT'] !!}

@endif @if(isset($formMetaObj['meta']['AGREEMENT_10_BULLETS']) && is_array($formMetaObj['meta']['AGREEMENT_10_BULLETS']) && count($formMetaObj['meta']['AGREEMENT_10_BULLETS']) > 0)

@foreach($formMetaObj['meta']['AGREEMENT_10_BULLETS'] as $bullet)
• {!! $bullet !!}
@endforeach

@endif @if(isset($formMetaObj['meta']['AGREEMENT_10_CONTENT_1']))

{!! $formMetaObj['meta']['AGREEMENT_10_CONTENT_1'] !!}

@endif @endif @if(isset($formMetaObj['meta']['AGREEMENT_11_TITLE']) && isset($formMetaObj['meta']['AGREEMENT_11_CONTENT']))

{!! $formMetaObj['meta']['AGREEMENT_11_TITLE'] !!}

{!! $formMetaObj['meta']['AGREEMENT_11_CONTENT'] !!}

@endif @if(isset($formMetaObj['meta']['AGREEMENT_12_TITLE']) && isset($formMetaObj['meta']['AGREEMENT_12_CONTENT']))

{!! $formMetaObj['meta']['AGREEMENT_12_TITLE'] !!}

{!! $formMetaObj['meta']['AGREEMENT_12_CONTENT'] !!}

@endif @if(isset($formMetaObj['meta']['AGREEMENT_13_TITLE']) && isset($formMetaObj['meta']['AGREEMENT_13_CONTENT']))

{!! $formMetaObj['meta']['AGREEMENT_13_TITLE'] !!}

{!! $formMetaObj['meta']['AGREEMENT_13_CONTENT'] !!}

@endif @if(isset($formMetaObj['meta']['AGREEMENT_14_TITLE']) && isset($formMetaObj['meta']['AGREEMENT_14_CONTENT']))

{!! $formMetaObj['meta']['AGREEMENT_14_TITLE'] !!}

{!! $formMetaObj['meta']['AGREEMENT_14_CONTENT'] !!}

@endif

Payment Information

@if(isset($formMetaObj['meta']['AGREEMENT_6_TITLE']) && isset($formMetaObj['meta']['AGREEMENT_6_BULLETS']) && is_array($formMetaObj['meta']['AGREEMENT_6_BULLETS']) && count($formMetaObj['meta']['AGREEMENT_6_BULLETS']) > 0)

{!! $formMetaObj['meta']['AGREEMENT_6_TITLE'] !!}

@foreach($formMetaObj['meta']['AGREEMENT_6_BULLETS'] as $bullet)
• {!! $bullet !!}
@endforeach

@endif @if(isset($formMetaObj['meta']['FEES_AND_PAYMENT_CONTENT']))

{!! $formMetaObj['meta']['FEES_AND_PAYMENT_CONTENT'] !!}

@endif @if(isset($formMetaObj['meta']['FEES_AND_PAYMENT_CONTENT_1']))

{!! $formMetaObj['meta']['FEES_AND_PAYMENT_CONTENT_1'] !!}

@endif