Please complete this intake form before your scheduled consultation, coaching, or training session so I can better understand your specific needs.

Our Core Philosophy: We provide tools and guidance to help you navigate and manage your child's meltdowns, not just stop them quickly.  Please know that results vary for each family, but we are committed to making your progression our highest priority. 

All information collected in this form will remain confidential and will be used solely for consultation, coaching, or training purposes.

Instructions & Important Note: After you submit this form, please visit J Atifa RN Support Services to schedule a time for your consultation, coaching, or training session.

If you have any questions or want a copy of your completed form, please email jalelah@jatifarnsupportservices.com.

NOTE: The suggestions I share are based on my nursing knowledge, but they are not medical advice or a diagnosis. If you have any health concerns, please talk to your doctor or healthcare provider.