Parent Coaching Registration and Agreement

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Name(s) *

Email(s) *

Phone number(s)

Children's names and ages (kept confidential) *

Your reason for seeking parent coaching. *

Behavior concerns or life circumstances, such as illness or trauma (children of all ages)

Desire for co-parent separation in a non-adversarial way

Other:

Please share your best outcome from parent coaching. *

Strengthening of our parent/child relationship

Learning to provide effective emotional support for the child(ren)

Improving child behaviors

In the case of separation, making it non-adversarial, using collaboration between co-parents

Help for sibling conflict

School concerns (behavior and/or academic)

Other:

For separating co-parents, please indicate your priorities *

Collaborating on decisions, avoiding animosity for everyone's sake

Saving expensive and/or ongoing attorney fees

Effective communication regarding schedules, including flexibility when a change is necessary

Supporting children emotionally during the transition to 2 households

Ongoing support as everyone adjusts to the changes

Other:

Client-Coach Agreement - please mark each *

I understand that the purpose of parent coaching is to assure the best interests of the child while supporting parents in proven communication methods.

I understand that Tina will demonstrate and help to maintain a non-judgmental environment during the coaching sessions.

Tina Feigal will maintain confidentiality regarding what you share in sessions unless you need her to connect with another professional and a Request for Information is signed by all.

The Zoom coaching sessions will be 90 minutes for the first appointment and 60 minutes for the subsequent 3 sessions. If needed, sessions can be added.

The 4-session package will be $900, with subsequent optional sessions at $200 each, payable on Venmo or a suitable option.

I commit to attending the sessions on time, respecting the needs of all involved. Cancellations must be made 24 hours in advance, unless due to an emergency.

I understand that parent coaching is not therapy, nor legal advice. If either is needed, Tina will help to secure it with recommendations.

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms