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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?

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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).

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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).

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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).

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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).

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

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

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

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