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Child Abuse Healing Form




Use my Child Abuse Healing Form for gauging whether or not you've been abused as a child. Many of us who have been abused as children aren't always sure because we blame ourselves for the harm that was done to us.

If we don't make that one time admission that we were abused and victimized, then we can't move forward. We'll be left to live in the past daily, thus ruining our ability to lead happy successful and fulfilled lives.

To help you be aware of the importance of recovery, I've provided a list of available assistance.  You can:

  1. Go to my presentation for a better understanding of child abuse recovery.
  2. Fill out my Child Abuse Victim Healing Form (below) to understand if you are a child abuse victim.
  3. Visit Child Abuse Healing to be assured that you did not cause your abuse.
  4. You can anonymously journal your abuse to begin recovery and begin a renewed life.
  5. Arrange a free consultation to begin my Christian Coaching program specifically for adults who have suffered from Child Abuse. 
  6. Visit my new Child Abuse Recovery website.  You'll find a growing list of self-help information and one of the most exciting, innovative and effective recovery programs designed specifically for adult victims of child abuse.    
No matter what help you choose, please do something! Your life is precious and you can change it no matter what your age or what is happening in your life right now. Check your local area or your church for programs.

 

If you're ready, fill out the child abuse healing form below as honestly as possible and then I'll get back to you shortly to confirm or assist you in knowing that you have been abused to help you move forward.   If you have requested to be notified of my new website for adult victims of child abuse fill in only that portion of the form and click on "submit."  Please read our privacy policy.  We do not spam.

  





Please note that all fields followed by an asterisk must be filled in.
First Name*
E-mail Address*
Who Was Your Major Caretaker?
A Parent
B Relative
C Friend
D Baby Sitter
E Day Care
F Family
How Did You Feel As A Child?
A Happy
B Sometimes happy
C Sad
D Introverted
E Hopeless
F Crying Often
G Introverted
H Despondent
I Quiet, Spoke Rarely
J Extremely Shy
K Stuttered Often
Explain Why You Were Unhappy, Depressed, etc.
Adult Child Abuse Victim Website
A I want to be notified when your adult abuse victim website is ready.

Please enter the word that you see below.

  



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