2026 Private Family Intake Form
As of 01/01/26, we have a wait list of about 4-6 weeks for parent coaching and training services.

This form is for families to fill out on their own behalf and will get you on our wait list. Once on the wait list, you are under no obligation if you change your mind when a coach becomes available.  Please see our website for service, fee, and privacy policy information.

A  free virtual 30 minute consultation with our office is required prior to beginning services to discuss the nature of your request and clarify billing.  

When a coach is available, we will email and/or text you. All services are payable in full at that time. If you decline, we will delete your information.

If you are parents seeking specialized services due to custody disputes, divorce, separation, a court order, or lawyer recommendation, and both parents are ordered to attend sessions, each caregiver must submit their OWN form, regardless if you will attend sessions separately or together.

Please review the Memorandum of Understanding to further under our scope of service.  Submitting this Intake Form confirms your agreement to the terms of our service and a commitment to our fees. Please contact us at timeoutbehaviorcoaching@gmail.com or 507.254.7748 if you have further questions.

Thank you for your interest in our services.  It will be a privilege to work with you!
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