One limited voluntary agreement
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Optional blank sheet. Use only where appropriate for your privacy and circumstances. Do not add identifying or sensitive details unnecessarily. This is not therapy, legal advice, a safety assessment or a crisis service.

The practical decision needed now:
____________________________________________________________________
____________________________________________________________________

Whether contact is safe and wanted:
____________________________________________________________________
____________________________________________________________________

The exact scope I am willing to accept:
____________________________________________________________________
____________________________________________________________________

One relevant action and its agreed finish line:
____________________________________________________________________
____________________________________________________________________

Who accepted responsibility for organizing it:
____________________________________________________________________
____________________________________________________________________

Relevant confirmation we both accept:
____________________________________________________________________
____________________________________________________________________

How an exception will be communicated:
____________________________________________________________________
____________________________________________________________________

The review point for the task, not a forgiveness deadline:
____________________________________________________________________
____________________________________________________________________

What actually happened:
____________________________________________________________________
____________________________________________________________________

My next choice and the limit that remains:
____________________________________________________________________
____________________________________________________________________

Original educational worksheet — RelateWell Guide
Article: https://relatewellguide.com/articles/apology-forgiveness-rebuild-trust-slowly/
Editorial revision: 2026-11-04