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Parent Coaching Intake Assessment

This Intake Assessment will help me get up to speed with your situation, and provide a good baseline for us to start with when setting your goals and defining the process.

Your responses are completely confidential. Please provide as much detail as you feel comfortable with.

This assessment needs to be completed prior to our first session.

Please Click the button below to start.

Start

Question 1 of 11

What is your teenager's name and age?

Question 2 of 11

How would you describe your relationship with your teenager at present?

A

Non - existent

B

Very strained

C

We exist in the same house - but don't feel connected

D

Okay most of the time, but there are issues that regularly flare up

E

We had a close relationship, but I feel increasingly disconnected from them

F

We get on well, there but there is are issues that I want to be able to help them with but don't know how

G

We have a good relationship and enjoy being with each other

Question 3 of 11

Who else is living at home? i.e. Partner / No partner, other kids and their ages etc.

Question 4 of 11

Does your teenager regularly spend time living in a different house with another parent or family member?

Question 5 of 11

Are you or your teenager currently participating in any type of counseling or psychological therapy?

Question 6 of 11

What are the main issues with your teenager you hoping to resolve through this process? Be as detailed as you can.

Question 7 of 11

What would be the ideal change you would like to see in your teenager by the end of this process? How do you hope  he/she will be different?

Question 8 of 11

If your teenager does change in the way you hope, what difference would that make to you and how you feel about parenting and your teenager?

Question 9 of 11

What are hoping to change in yourself and in your parenting through this process?

Question 10 of 11

If I was to ask your teenager what their main issues were with you, what do you think they would say?

Question 11 of 11

Is there anything else you would like me to know about your situation or hopes for this process?

Confirm and Submit