(Please fill out only after speaking with Linda or Ty concerning your situation)
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1. What are the names, sex and ages of your children?
2. What grade is each child in school?
3. What are your current occupations and how many hours does each parent generally work a week?
4. What self-help skills do each of your children do for themselves? i.e. make their own bed, get themselves up in the morning.
5. How many hours a day and or per week are you allowing for each technology in your home? (Include all forms i.e. TV, laptop, iPad, gaming machines, movies, etc...)
6. What chores/responsibilities do each of your children have around the house? i.e. take out the trash, feed a pet, clean dishes.
7. Who do your children live with?
8. What is your parenting style? What is your partner's parenting style? How do you currently handle conflicts and challenges with your children?
9. Have there been any "changes" in your home recently including health challenges?
10. What professional assistance have you tried if any, including medications?
11. How were you parented in your family?
12. What are your main concerns and challenges with each of your children?