We'll never get sick of hearing about your breakup.
In this assessment, we'll ask you questions to help you reflect on your breakup and better understand how we can help you mend.

When you complete and submit it, we'll send you our Quickstart Mend Guide and a link to begin your free Heartbreak Cleanse. Are you ready to Mend?
Kewl, let's start
 
What is your gender? *




 
How old are you? *


 
What best describes your marital status? *


 
What is your email address? *

Example: ellen@letsmend.com

We'll send your Mend Quickstart guide when you're done.
 
Alright, let's talk about your breakup shall we?

In the immortal words of Kid Ink, "Let's just be honest. Let's be real."
 
First off, are you going through a breakup? *

The rest of these questions are about your breakup. You can still continue if you're not going through a breakup, but just a heads up!

 
When did the breakup happen? *

Guesstimate if you can't remember.
 
On a scale of 0-10, how is your breakup interfering with your ability to live daily life? *

There's no right or wrong answer here.
 
What do you think is the main reason you broke up? *


 
How would you describe the breakup? *

It's okay, no one's judging.

 
The hardest part about the breakup is *

Breakups are really hard. This list captures some of the things we hear most often, but if we missed the hardest part for you, please select Other and let us know.

 
Who/what has helped you through your breakup? *

List anything/everything that has helped you mend.
 
How long do you think it will take you to move on from this breakup? *


 
Alright, now for some fun. This is what will help us help you.

 
If you could ask a fairy godmother anything about your breakup, what would you ask her? *

 
What do you need most right now? *

 
Don't forget to click "I'm ready to submit" to finish.

When you do, we'll send you our Mend Quickstart Guide and a link to begin your free Heartbreak Cleanse.

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