Parenting From The Heart Coaching Questionnaire

(Please fill out only after speaking with Linda or Ty concerning your situation)

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Phone Number

1. What are the names and ages of your children?

2. What grade is each child in school?

3. What self-help skills do each of your children do for themselves? i.e. make their own bed, get themselves up in the morning.

4. What chores/responsibilities do each of your children have around the house? i.e. take out the trash, feed a pet, clean dishes.

5. Who do your children live with?

6. What is your parenting style? What is your partner's parenting style? How do you currently handle conflicts and challenges with your children?

7. Have there been any "changes" in your home recently including health challenges?

8. What professional assistance have you tried if any, including medications?

9. How were you parented in your family?

10. What are your main concerns and challenges with each of your children?