First Appointment Orientation

Parent Coaching & Transitional Support

Thank you for choosing Solutions Parenting Support for your transitional support services. We recognize you have many choices and appreciate your trust in us. Please complete the first appointment orientation paperwork prior to your first coaching session. Completing the paperwork allows us the opportunity to spend a greater amount of time on coaching and supportive care rather than on administrative.

Continue to scroll down for initial information gathering.

Your Name*
First Last
Your Email*
Parent/Guardian Information
Parent/Guardian Names:
Parent's Marital Status
Child's Living Arrangement
Parent 1 Information
Parent's Name
First Last
Parent's Email
Parent's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent's Home Phone
Parent's Work Phone
Parent's Mobile Phone
Parent 2 Information
Parent's Name
First Last
Parent's Email
Parent's Address (if different from Parent 1)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent's Home Phone
Parent's Work Phone
Parent's Mobile Phone
Child's Information
Child's Name
First Last
Birth Date
Grade in School
Name and Age of Siblings Living in the Home
Professional Resources
Referral Resource for Parent Coaching
Name of Most Recent Program/Therapeutic School
Name of Program Therapist
Name of Program Therapist
Therapist's Phone Number
Therapist's Email
Name of Most Recent (Active) Home Therapist
Therapist's Phone Number
Therapist's Email
Educational Information
Name of School Child Will be attending:
Grade
Type of School (Private, Public, Community College, Other):
Contact Person & their title for collaborative work:
Describe the process of the change within the family system and relationship with your child that took place while he/she attended his/her most recent placement:
Describe your past and current parenting style: (include current strengths and weaknesses):
Describe your parenting goals both for yourself and with your parenting partner:
Describe any relevant social, emotional or traumatic changes or experiences that have taken place with anyone within the family system pre/during/post therapeutic placement/treatment. i.e. disclosures, marital change:
Additional Comments
Would you like to receive regular parenting support articles and be added to our email list?
- Yes, please!
Comments
This field is for validation purposes and should be left unchanged.

Save and Continue Later

First Appointment Orientation

Parent Coaching & Transitional Support

Parent/Guardian Information

Parent 1 Information

Parent 2 Information

Child's Information

Professional Resources

Educational Information