Questionnaire initial interview

Questionnaire for Initial Interview

Would you like to register for an initial consultation to consider whether we would like to work together for a while? Wonderful! Then please fill out this questionnaire to give me a first impression of what you are looking for so that we can use our 20-minute initial meeting as effectively as possible.

As soon as I have received your booking and the completed questionnaire, and which times/weekdays between 9am and 5pm generally suit you, I will get back to you with my next dates for our initial consultation.

Questionnaire for Initial Interview

First and last name

E-mail

Street & house number

ZIP CODE

Town & Country

I am a mother/ father/ caregiver (please specify in each case)

First and last name of the child + date of birth

Please describe your child, its STRENGTHS + what it likes to do so that I can get an idea:

Please describe your child and his/her INTERESTS so that I can get an idea:

Please describe 1-3 problems that you as a parent/caregiver are concerned about:

Please name 1-3 questions for which you as a caregiver are looking for parent coaching:

I understand that Sibylle Janert mainly offers relationship-oriented parent counseling online, and that therapy sessions may be possible as part of an existing longer collaboration (e.g. annual package)

Online

mostly online via Zoom and via short videos of our child to find new ways together with parents to help my child by myself at home

Consulting

Private as an independent consultation (hourly rate: Euro 120), i.e. not covered by health insurance or similar

I have filled in all the relevant information about my child and would like to book an initial consultation. The following times of day are generally possible for me to talk undisturbed via Zoom about my concerns and questions (e.g. mornings, Mondays only, ...):

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Registration: Initial Meeting

Questionnaire for Initial Interview

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Registration: Initial Meeting

Questionnaire for Initial Interview

More info on the topic?

You have Successfully Subscribed!

16 Key Strategies for DIRFloortime PlayFREE Download

You have Successfully Subscribed!

16 Key Strategies for DIRFloortime Play
FREE Download