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:
Parents Marital Status
Child's Planned Living Arrangement
Mother's Information
Mother's Name
First Last
Mother's Email
Mother's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mother's Home Phone
Mother's Work Phone
Mother's Mobile Phone
Father's Information
Father's Name
First Last
Father's Email
Father's Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Father's Home Phone
Father's Work Phone
Father'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!
Email
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

Mother's Information

Father's Information

Child's Information

Professional Resources

Educational Information