Deconstruction Clarity Intake | Dr. Vanessa R. Brooks

1

Let me know who I am speaking with.

Basic contact information and a few details that help me communicate with you appropriately.

First name *

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Last name *

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Email address *

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Phone number

Pronouns

Time zone *

Please select your time zone.

Are you 18 years of age or older? *

Yes No

This service is currently designed for adults 18 and older.

How may I contact you about this intake? *

Email Text message Either is fine

Please select a contact preference.

How did you hear about me? *

Please tell me how you heard about this service.

Please tell me where.

2

Where are you in the process?

There is no “correct” stage of deconstruction. I am looking for context, not the right religious answer.

Which statement most closely describes where you are right now? *

I still identify as Christian and am questioning parts of what I was taught. I am reconstructing my Christian faith on different terms. I believe in God or the Divine but am unsure about Christianity. I am spiritually open and still deciding what I believe. I no longer identify as religious. Other

Please select the statement that fits most closely.

Describe where you are in your own words.

What parts of your faith, relationship with God, or spiritual life do you want to preserve—if any?

Which stage feels closest to your experience? *

Just beginning to question Actively examining beliefs Left a religious environment and processing Rebuilding or reconstructing Stuck between what I was taught and what I now know I am not sure

Please select the stage that feels closest.

How long have you been questioning or deconstructing?

What most contributed to this season of questioning? * Select all that apply.

A doctrine or teaching stopped making sense Harmful church or ministry experiences Biblical or historical research The impact of beliefs on my mental or emotional well-being Family, marriage, or relationship conflict Changes in identity, values, or life direction A recent event intensified my questions Other

Please select at least one answer.

What happened recently, and what questions did it raise?

What else contributed?

Are you currently connected to a church, ministry, or religious community? *

Yes No It is complicated

Please select one answer.

How safe or unsafe does it feel to ask questions in that environment?

3

What are you trying to understand?

This section helps me identify the question underneath the question—and where inherited beliefs may still be shaping your life.

Which topics are you currently examining? * Select all that apply. You do not need to choose only one.

Please select at least one topic.

What other topic would you like to examine?

What is the primary question you want help thinking through? * Write it plainly. It does not need to sound academic or spiritually acceptable.

Please tell me the main question you want to examine.

Where is this uncertainty or religious conditioning showing up in your life? *

Mental or emotional distress Self-trust, decisions, or fear of being wrong Family, marriage, friendship, or community relationships Work, leadership, business, money, or visibility Identity, values, purpose, or belonging Spiritual practices or relationship with God Body, health, rest, sexuality, or boundaries It is not significantly affecting my daily life

Please select at least one area.

What would feel useful at the end of our work together? *

Language for what I am experiencing Research and historical or biblical context Clarity about what I believe now Help separating God from harmful teachings A decision, boundary, or next step A personal reconstruction framework A place to think without being corrected or shamed I am not sure yet

Please select at least one desired outcome.

What have you already tried?

What would not feel supportive to you?

4

What kind of support are you looking for?

This does not lock you into a package. It helps me understand the level and format of support you have in mind.

Which option interests you most right now? *

A one-time private intensive
Focused examination of one central question, doctrine, or decision. Short-term private support
Several sessions for a more layered deconstruction or reconstruction process. I am not sure
I would like a recommendation after you review my intake.

Please select the option closest to what you need.

Preferred meeting format *

Zoom video Phone / audio No preference

Please select a meeting format.

When would you like to begin? *

As soon as available Within 2–4 weeks Within 1–3 months Gathering information

Please select a timeframe.

What kinds of support have you used before? Select all that apply.

Therapy or counseling Pastoral care or spiritual direction Coaching or consulting Academic or independent research Peer or community support None

Are you currently working with a licensed mental-health professional? *

Yes No Prefer not to say

Please select one answer.

How would you like this consultation to complement that work?

Do you need any accessibility or communication accommodations?

What else would help me understand what you need?

5

Make sure the scope feels clear.

These boundaries protect both of us and help ensure that the service matches what you are actually seeking.

What this service provides: educational consultation, theological and historical examination, guided reflection, belief-system mapping, decision support, and reconstruction planning.

Are you primarily seeking immediate crisis or emergency mental-health support right now? *

No Yes

Please select one answer.

Please do not wait for a response to this form. This consultation cannot provide emergency intervention, crisis care, or immediate mental-health treatment. Seek urgent assistance from local emergency services or a qualified crisis or mental-health provider in your area.

I understand that submitting this form is not a substitute for urgent or emergency support.

Submitting this form does not guarantee acceptance or create a client relationship. A service relationship begins only after fit is confirmed, terms are accepted, and payment or other onboarding requirements are completed.

6

Review before you submit.

Make sure your contact information and central question are correct. Use the edit links to return to any section.

Your answers are shown below exactly as they will be submitted.

Type your full name as your electronic signature *

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Date *

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I have reviewed my answers and want to submit this intake. *

By submitting, you acknowledge that this intake is for service-fit review only and is not monitored for emergencies.