Onboarding Intake Form

🌱 Preventative Parenting Onboarding Intake Form

We’re here to help you create real, lasting change in your parenting journey. This isn’t a checklist — it’s a chance for you to pause, reflect, and uncover what’s really been going on beneath the surface. The more honest and specific you are, the faster we can create a game plan that works.

First Name *

Last Name *

Phone *

Email *

Section 1: About You & Your Family

1. What’s your child’s age(s)? *

2. In a few words, how would you currently describe your relationship with your child(ren)? *

Section 2: The Challenges You’re Facing

3. What are the 3 most recent situations where you felt frustrated, stuck, or unsure as a parent? Please describe them in detail. *

4. On a scale of 1–10, how stressed or overwhelmed do you currently feel in your parenting? Why that number? *

5. What patterns do you notice keep repeating in your home that you’d love to finally break? *

Section 3: Your Beliefs About Parenting

(These aren’t “right or wrong” — they’re here to surface what you’ve been taught and what you currently believe.)

6. When your child resists your instructions, what do you feel should happen next? *

a) They should follow because I’m the parent.

b) They should follow if they understand and respect the reason.

c) Other (please explain below).

👉 If you chose “Other” above, tell us what you believe should happen in that moment and why.

7. Do you believe respect is something children owe their parents automatically, or something that is built through mutual trust and connection? Why? *

8. Growing up, how did your parents handle discipline with you? How do you think that shaped the way you parent today? *

9. What’s one parenting belief you’ve always carried… that deep down you suspect might not be serving you anymore? *

Section 4: Your Desired Outcomes

10. Imagine 6 months from now: what would the ideal parent-child relationship look like for you? *

11. What would your home feel like if the daily struggles you face right now were no longer an issue? *

12. What’s the biggest win you’d love to experience in the next 30 days? *

Section 5: Final Reflection

13. If you had to sum up in one sentence the #1 challenge that keeps you up at night as a parent, what would it be? *

14. And in one sentence — what’s the dream outcome you’d love to achieve with your child(ren)? *