Solutions Parenting Support Intake Survey

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* 1. Please share your name and the name of the person who referred you to us.

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* 2. What is your child's current situation?

Young adult in Wilderness Therapy

Adolescent in Wilderness Therapy

Adolescent transitioning home from Wilderness Therapy

Young adult transitioning home from Wilderness Therapy

Adolescent in Residential Treatment

Adolescent transitioning home from Residential Treatment

Young adult transitioning from Residential Treatment

Young adult home/never attended Residential or Wilderness Treatment

Adolescent home/never attended Residential or Wilderness Treatment

Young adult home/has attended Residential or Wilderness within 2 years

Adolescent home/has attended Residential or Wilderness within 2 years

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* 3. Describe your child's unique profile and learning style.

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* 4. Rate your understanding of your child's strengths and struggles (1 is low and 5 is high).

Please share:

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* 5. Rate your ability to establish and follow through with boundaries and expectations based on your child's unique profile (1 is low and 5 is high).

Please explain:

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* 6. Rate your ability to identify what you do and don't have control over in the parent-child dynamic (1 is low and 5 is high).

Please share:

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* 7. Rate your ability to recognize how your emotions contribute to the overall tone of the household (1 is low and 5 is high).

Please share:

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* 8. If co-parenting, is it in a intact or split family (if applicable)?

Intact

Split

Other (please specify)

Solutions Parenting Support Intake Survey

Question Title

* 1. Please share your name and the name of the person who referred you to us.

Question Title

* 2. What is your child's current situation?

Question Title

* 3. Describe your child's unique profile and learning style.

Question Title

* 4. Rate your understanding of your child's strengths and struggles (1 is low and 5 is high).

Question Title

* 5. Rate your ability to establish and follow through with boundaries and expectations based on your child's unique profile (1 is low and 5 is high).

Question Title

* 6. Rate your ability to identify what you do and don't have control over in the parent-child dynamic (1 is low and 5 is high).

Question Title

* 7. Rate your ability to recognize how your emotions contribute to the overall tone of the household (1 is low and 5 is high).

Question Title

* 8. If co-parenting, is it in a intact or split family (if applicable)?

Question Title

* 9. Describe your strengths and struggles as a parent and a co-parent.

Question Title

* 10. If applicable, what are the strengths and struggles in the co-parenting dynamic?