💛 SECTION 1: ABOUT YOU

Your first name *

Your email address *

🧒 SECTION 2: CHILD BASICS

Your child’s first name *

Your child’s age *

Who does your child spend most of their time with? *

If you had to describe your child in a few words, what would you say? *

What do you love most about your child? *

What feels hardest about parenting your child right now? *

Are there certain times of day that feel especially difficult? *

What big emotions does your child struggle with most? *

What do those big feelings usually look like in your child? *

What seems to trigger these big feelings most often? *

What have you noticed helps your child calm down — even a little? *

What behaviors are you most concerned about right now? *

How do you usually respond when those behaviors happen? *

What happens most often when you try to set limits? *

How are mornings and bedtimes going in your home? *

How does your child handle transitions (stopping play, leaving the house, changing activities)? *

How does your child seem to learn best? *

What helps motivate your child to cooperate or try new things? *

Have you noticed any sensory sensitivities or physical needs? *

How does your child usually act when they’re tired, hungry, or overstimulated? *

How does your child do in public or social settings? *

Are there any situations you tend to avoid because they feel too hard right now? *

How would you describe your parenting approach? *

What feels most challenging for you emotionally as a parent right now? *

What do you wish you felt more confident about in parenting? *

If this plan worked really well, what would feel different in your home a few months from now? *

Is there anything else you want us to know about your child or your family? *