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Medina Parent Coaching Application Form

Thank you from the bottom of my heart for your interest in 1:1 Parent Coaching here at Medina Parent Coaching. This short application helps me understand your family, your challenges, and whether my coaching is the right fit for you right now.

If your application is approved, you'll be invited to book a private 1:1 zoom session with myself using a secure link.
Please note: Completing this form does not guarantee a booking. We will keep your details on file and will let you know when a slot becomes available.

Let's get to know you...

What is your current relationship status

I.e Married, Single, Co-parenting, living together.

How many children do you have?

What age are your children/child?

Does your child/children have any confirmed learning difficulties?

Does your child/children have any confirmed learning difficulties?

What are the main challenges you're facing with your child/children at the moment?

E.g. meltdowns, tantrums, anxiety, sibling rivalry, defiance, emotional outbursts.

When do these challenges tend to show up?

e.g mornings, bedtime, school run, transitions, all the time

How is this behaviour affecting you emotionally as a parent right now?

What are you hoping I can help you with specifically?

Why do you feel parent coaching is for you?

Done!

Your registration is completed. We will be in touch asap to let you know if you have been accepted.