Name *

First Name

Last Name

Phone *

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Which of the following best describes your parenting outlook? *

I just need my child to listen, obey, and comply, and then I can have more peace.

Something is not working, and I can't tell if it's me or my child.

My child is struggling and I am aware that I need to be the change in order for things to improve.

How familiar are you with conscious parenting (also referred to as positive parenting, peaceful parenting, mindful parenting, gentle parenting, empowered parenting, etc.)? *

Very familiar! I've read books, listened to podcasts, and/or follow conscious parenting advocates.

Sort of familiar. I generally know what the terms mean and have a basic understanding.

Not that familiar. I may have heard of the terms before but am fairly new to the idea.

Never heard of it.

How open are you to a conscious parenting approach for your family? *

Very open. I fully support the idea of parents being the change that their children need.

Even though I am new to the idea, I am willing and excited to learn and explore.

I have heard of it, but I don't think it's for me.

I haven't heard of it, but I am ready to explore it to see if this would be a good approach for my family.

I haven't heard of it, and I don't think it's for me.

Hiring me as your professional parenting coach for the 12 weeks is an investment of $3500. Are you willing to invest this amount? *

Yes

No

Not sure how but I am willing to get creative on how I will come up with the necessary amount to invest in my family.

How ready are you to make changes in your parenting? *

Absolutely ready now.

I think I'm ready, but I have some questions and need more information.

I changed my mind, I don't feel ready yet and need more time.

I am a human.

If yes, check box.