STEP 3 - Parent Questionnaire -

PARENT QUESTIONNAIRE

Please complete this questionnaire before our first session

Today's Date *

Parent(s) name(s) *

Address *

Phone Number *

Child/Children’s Names & Ages *

1. What 2 or 3 aspects of your parenting make you the most proud? *

2. What about your parenting would you like to improve? *

3. What does your child(ren) do(does) that delights you? *

4. What 1 or 2 challenges does(do) your child(ren) have that you’d like to address in our sessions? *

5. What aims do you have regarding your family’s physical health? *

6. What aims do you have regarding your family’s emotional health? *

7. What aims do you have regarding your family’s mental health? *

8. What aims do you have regarding your family’s intuitive, spiritual, and/or moral health? *

9. What is the best part of a typical day with your child(ren) and why is it the best? *

10. What is the most challenging part of a typical day with your child(ren) and why is it challenging? *

11. What changes would you like to see in your family’s life? What’s an example of how that would look? *

12. What changes would you like to see in your personal life? What’s an example of how that would look? *

13. Anything else you’d like to share? *

Signature

Date *

STEP 3 – Parent Questionnaire