Parent Coaching Intake Form

First Name *

Last Name *

Email Address *

I agree to receive emails from Dena McComb

Where is your greatest frustration with your relationship with your child? *

What are your child's strengths? *

What are your child's challenges? *

Where do you struggle most when it comes to parenting your child? *

What do you feel your fears are around your relationship with your child? *

What parenting style do you feel that you gravitate towards and why? authoritative (high expectations with warmth and support), authoritarian (high demands, low support), permissive (low demands and high support), and uninvolved (low demands and low support) *

What parenting style would you want to be more like and why? authoritative (high expectations with warmth and support), authoritarian (high demands, low support), permissive (low demands and high support), and uninvolved (low demands and low support) *

What is ONE thing you want more of in your life as a parent and mom/dad right now? *

Is there anything else you would like me to know about you?

I do hereby attest that this information is true, accurate and complete to the best of my knowledge.

Type your Full Name (First and Last) *

Date *

Parent Coaching intake form