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Expectations
01
Initial Contact
02
Personal details
03
Waiver of Confidentiality
04
Children Details
05
Family Origin
06
Protective Services
07
Courts
08
Mental Health
09
Discipline
10
Expectations
11
Drug and Alcohol
In what areas would you like more knowledge or skills?
Supervision:
Yes
No
Nutrition:
Yes
No
Medication:
Yes
No
Discipline:
Yes
No
Behavioral:
Yes
No
Age Appropriate Expectations:
Yes
No
Health Issues:
Yes
No
Education:
Yes
No
Consistency of Follow Through:
Yes
No
Agreements Between Parents:
Yes
No
Step-Families:
Yes
No
Budgeting and Finances:
Yes
No
Dealing with a special needs child:
Yes
No
Custody issues or Split Parenting concerns:
Yes
No
Children who have been physically/sexually abused:
Yes
No
Night time problems (nightmares, bed wetting, staying in bed, etc.):
Yes
No
Behavioral problems at school:
Yes
No
School grades:
Yes
No
Self esteem:
Yes
No
Sex education with your child:
Yes
No
Mental Health issues:
Yes
No
Drugs and Alcohol:
Yes
No
In-Laws:
Yes
No
Extended Families:
Yes
No
Defiant or Oppositional Child:
Yes
No
Other:
Yes
No
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Home
Services
About
Contact Us
Home
Services
About
Contact Us
