Client Intake Form

First Name

Last Name

Preferred Email

Preferred Phone

Address

Briefly describe the reason(s) you are seeking parent coaching:

After your parent coaching process is complete, what do you want to have accomplished/attained?

Give the current roadblocks in the way of the above accomplishment.

What do you most appreciate about your current situation?

What are your family's strengths?

Please give the name(s) and age(s) of your child(ren) and then list each individual's strengths.

List your strengths.

Who are your best supporters?

How do you take care of yourself so you can parent well?

What background information can you provide that you think will be most helpful in your coacing experience? Are you or any of your children receiving counseling?

Complete this thought: After coaching I would like my life to look like...

PARENT COACHING

Client Intake Form

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