Intake Questionnaire

Welcome!

I’m very much looking forward to getting to know you and working with you. To make our process most efficient and for you to get the most out of it, I like to have you do some thinking and sharing ahead of time. Please chew on the following questions.

Before our first appointment, being as thoughtful and honest as possible, please answer the questions below and submit. It’s my hope that you can really show me who you are, by being vulnerable and open. This will allow our work to be meaningful from the get-go.

Being a parent is a great honor. Being your coach is likewise something I take very seriously; I will hold your answers to these questions with respect and in gratitude. Thank you, in advance, for sharing and for allowing me to support you on this journey of love.

Name

First Name

Last Name

Email Address

Please list your values in life and then highlight the top ones, in other words the ones you want to ensure you pass down.

Please share with me WHO your child IS (children are). Please slow down, sit back and have a good look.

What’s hardest for you as a parent - those times that make you want to give up?

What’s natural or easy for you as a parent? Not necessarily just what's fun but what skills do you bring to the table as far as modeling and teaching?

What do you do when you fail or make a mistake (in parenting and otherwise)?

How honest do you consider yourself to be about yourself? And, in that same spirit, what does your inner voice sound like?

How were you parented?

What are your biggest triggers?

In parenting, what are your biggest fears?

What kind of human(s) would you like to raise - with what qualities - and how often do you think about this?

Intake Questionnaire

True nature | True nurture

J E N N W E R T