Full Name *

Phone *

Email *

What brings you here? (Select All that Apply) *

I want to improve my relationship with my child(ren)

I feel overwhelmed or stuck in my parenting

I’ve tried books, tips, or classes and still feel like something’s missing

I’m looking for a diagnosis or therapy for my child

I want someone to fix my child’s behavior

I’m exploring general information – not ready to take action yet

Describe your current parenting challenges *

Have you ever worked with a coach or therapist before? *

Yes, a coach

Yes, a therapist

Both

No

If you answered yes to having received coaching or therapy, what was helpful or unhelpful about the experience? (N/A if no)

What are you currently looking for? *

Guidance, tools, and support to become a more confident and connected parent

Therapy or clinical diagnosis for yourself or your child

General parenting insights without committing to a structured program

Our program involves weekly commitments, reflection work, and action steps. Are you open and ready to actively participate in your growth? *

Yes, I’m ready to engage fully

Maybe, I have some hesitation

No, I prefer more passive support

Are you prepared to invest time, energy, and finances into a coaching program designed to transform your family relationships? *

Yes, I’m willing and able to invest

I’m interested but unsure about the investment

No, I’m not in a place to invest right now

What outcome or transformation would you most hope to gain from working together? *

Is there anything else you'd like me to know before we connect?

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