Intake Form

Please fill out this form and submit before your first appointment. Thank you!

Your name

Your email

Name of other adult(s) who will be attending sessions and your relationship (these could be your partner, co-parent, ex-spouse etc):

Name(s) and birthdate(s) of children:

Home address:

Phone number:

Do I have your permission to text you at this number?:

Primary reason(s) for appointment:

How did you hear about Handmade Parenting?:

If your child(ren) go to school, what school(s) do they attend?

If you work outside the home, what is your job?

N.B.: I am thoroughly trained and rooted in the Neufeld paradigm, experienced in working with parents and maintain a rigorous ethical standard, I am not, however, a licensed mental health practitioner.