top of page

Request a FREE Evaluation from PLC

About Our Intake Form

It is very important for cult intervention professionals to have all relevant information that may have a bearing on the case. It is assumed that the group member has divulged this information to the group. 

In the form below, we ask a number of detailed questions that will allow us to better understand your situation. 

This Form may take between 30-60 minutes to complete and will NOT save your progress if you close out your tab. This is to ensure that your answers and identity remain secure. 

The more information you can give, the more effectively we can evaluate your situation, strengthen or re-establishing your relationship, and plan for an effective Intervention or Mediation.

All questions require an answer to submit the form, but we do not necessarily expect you to have completely accurate information for every inquiry.


If there are any questions that you cannot answer, simply convey as much in the response section and move on. 

Please reach out to or if you require assistance completing this form. 

Wondering if this is the right form for you? Read more here.

Issues with our form? Please email us at for assistance. Thank you for taking the time to fill this out!

Anchor 1

This session is for you if...

• You have a friend, family member, or loved one who is cult involved or affected by undue influence. 

• You have questions about coercion, undue influence, and cult involvement's affects on an individual's health, personal freedom, and lifestyle. 

• Are seeking support of cult-aware professionals to assess whether intervention or mediation is an ethical course of action.  ​


An initial consultation will give you the ability to see whether services such as ours will be beneficial for your situation.  This 50-minute session is an opportunity to start an ongoing relationship with cult recovery specialists Ashlen Hilliard with People Leave Cults, and her mentors Patrick Ryan and Joseph Kelly with Intervention101 who can educate you, support you, and provide referrals to qualified professionals. 


• Initial evaluation requires the completion of a detailed intake form

• If the intake form is not completed by date of scheduled session, PLC and its partners reserve the right to cancel your session.​

• Established clients will be provided a separate fee schedule for ongoing consultations Cult intervention / mediation services are considered on a case-by-case basis according to each individual's situation.  ​


*Please note* This session is NOT an emergency service, therapy, or medical in nature. I am a consultant who offers resources, tools, and information so that you can determine the best route to move forward in your recovery journey. 

bottom of page