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
Birthdate:
Grade in school:
Name and age of siblings living in the home:
Professional Resources
Referral source for parent coaching (who sent you our way?):
Name of most recent program/therapeutic school:
Name of program therapist:
Therapist's phone number:
Therapist's email:
Name of child's most recent (active) home therapist:
Therapist's phone number:
Therapist's email:
Name of parent's most recent (active) therapist:
Therapist's phone number:
Therapist's email:
Educational Information
Name of school child will be attending:
Type of school (private, public, community college, other):
Contact person & their title for collaborative work:
Family Assessment
What have you learned about yourself and your family throughout the treatment process thus far?
List your child's most recent diagnoses, if applicable.
List the parents' most recent diagnoses, if applicable.
Describe your child's strengths and struggles.
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:
Describe any goals important to you to work toward during your time with Solutions Parenting Support.
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.

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First Appointment Orientation

Parent Coaching & Transitional Support

Parent/Guardian information

Parent 1 Information

Parent 2 Information

Child's Information

Professional Resources

Educational Information

Family Assessment