Onboarding Intake Form

Please be as honest and specific as possible so we can create an effective game plan that works specifically for your unique situation.

First Name *

Last Name *

Phone *

Email *

Section 1: Your Family

1. What are your children's ages? (List each child separately if more than one) *

2. Which child are you most focused on right now(Age + brief description — e.g. "My 3-year-old son")* *

Section 4: Your Beliefs

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

10. When your child has a meltdown or acts out, what's your gut reaction — what do you believe is happening? (What's your instinct about WHY they're doing it? *

11. When you think about the word "discipline," what does it mean to you? *

12. Growing up, how did your parents respond when you were struggling or acting out? How do you think that's shaped the way you parent today? *

13. What's one parenting belief you've held for a long time that, deep down, you're starting to question? *

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

Module 5: Your Fears And Goals

15. What's your biggest fear if nothing changes? (Not just what you want — what are you AFRAID will happen if this doesn't get fixed?) *

16. What does success look like for you — not in your child's behavior, but in how you feel as a parent? *

17. What's the one thing you most want to stop experiencing in your home? *

18. What's the one thing you most want to start experiencing? *

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

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

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

22. 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? *

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

24. And in one sentence, what's the dream outcome you'd love to achieve with your family? *

25. Finally, is there anything else you want me to know before we connect — about your child, your family, your situation, your fears, or your hopes? *