Full Name *

Email Address *

Child's Age *

What motivates your child (ex: learning independently or with others, etc) *

What is your child interested in: *

What are your child’s strengths: *

What is challenging for your child: *

Does your child have a formal diagnosis? *

Yes, it is:
Not formal, but I’m exploring:
I’d rather not respond

Does your child have a history of: *

Speech differences (delayed or early)

Motor skill differences (delayed or early)

Feeding and eating differences (picky eating or ARFID)

Learning differences (reading, writing, math)

Sensory differences

Describe your concerns: *

Managing meltdowns and big emotions

Anxiety and self-regulation struggles

Sensory sensitivities or sensory overload

Transitions and routine changes

Social interactions and making friends

School-related stress

Parent burnout and self-care

Understanding my child’s unique needs

Other

Tell us what this challenge looks like in real life. What typically happens before, during, and after the moments you're most concerned about? Knowing these details allows us to better support you with strategies that fit you and your child, your nervous systems, and your everyday life. *

List current strategies you are using when presented with this challenge: *

These strategies are effective: *

Are there other family members, educators or adults who would benefit from learning strategies to help your child/family dynamic? When it comes to supporting your child’s nervous system and sustainable change, the more people who are on the same page, the more optimal the results. Please let us know if you would like to include any of these people into our coaching sessions. *

If yes, I’d love for these people to be involved in our coaching sessions: *

Are there any resources or supports that would be helpful for your family right now? We know parenting a neurodivergent child can touch many areas of life and we also know many experts in other fields. If there are other supports that would make things feel more manageable, let us know. Some families find it helpful to explore: *

Speech or communication support

Nutrition or support with picky eating

Functional medicine or holistic health referrals

Physical therapy support

Psychology or psychiatry support

School or educational support

Burnout recovery or parent self-care strategies

You don’t have to figure it all out alone. If it matters to your family, it matters to us.

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1:1 Coaching

$350

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