The Healing Separation Agreement

Below you will find the first page of the Healing Separation Agreement. The topics covered in the Agreement include how long, your finances, housing, vehicles, children, bill paying, how you will use the time to heal/grow, and more. You don’t need gray areas in your separation. Make it clean. Determine ahead of time what is expected. Set yourselves up for success. If you need help negotiating facets of your agreement, I’m really good at it. Call me.

If you seek me out for help completing your Agreement, I’m glad to subtract the price you paid for this Agreement from my services.

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Healing Separation

Healing Separation Agreement

The intention of this Agreement is to create a clear and open space for an emotional separation and healing by designing agreements around important life areas that could cause conflict if not discussed. Guidelines are provided at the end of the Agreement by footnote. Every couple is different and your Agreement should reflect your unique needs.

Use this form as a guideline and adapt it to suit your unique relationship needs. Get someone to help you negotiate those hard to discuss items in this agreement. Depending on the state of your relationship, it may be hard to complete this on your own. There is some overlap in categories since many life areas overlap, also.

This Agreement is in no way to be construed as a legal document.Consult an attorney if a legal or structured separation is needed.

For simplicity, in this Agreement ________________(name) will be designated Partner One and ________________(name) will be designated Partner Two.


(Specify an agreed upon number of weeks, months, years, or an end date.)



(Supply time intervals or dates when you agree to re-evaluate this current Agreement.)

__________________________________ ______________________________

__________________________________ ______________________________


Supply time intervals or dates when you will meet together. You can use this time for catching up on each other’s lives and extended family, healing and growth practices, offering kindness, kid stuff. It’s best to keep it friendly.

If difficult discussions are anticipated it would be best to have those discussions with a third party such as a coach or therapist. Separations longer than six months should be evaluated with a helping professional at the 6-month mark.

First month:

________ x per _________________

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