{"id":7121,"date":"2022-07-25T08:18:40","date_gmt":"2022-07-25T06:18:40","guid":{"rendered":"https:\/\/divi5.janert.info\/?page_id=7121"},"modified":"2026-10-17T13:42:29","modified_gmt":"2026-10-17T11:42:29","slug":"questionnaire-first-interview","status":"publish","type":"page","link":"https:\/\/janert.info\/en\/fragebogen-erstgespraech\/","title":{"rendered":"Questionnaire initial interview"},"content":{"rendered":"<div class=\"et_pb_section_0 et_pb_section et_section_regular et_block_section\"><div class=\"et_pb_row_0 et_pb_row et_block_row\"><div class=\"et_pb_column_0 et_pb_column et_pb_column_2_3 et_block_column et_pb_css_mix_blend_mode_passthrough\"><div class=\"et_pb_text_0 et_pb_text et_pb_bg_layout_light et_pb_module et_block_module\"><div class=\"et_pb_text_inner\"><p>&nbsp;<\/p>\n<\/div><\/div><div class=\"et_pb_text_1 et_pb_text et_pb_bg_layout_light et_pb_module et_block_module\"><div class=\"et_pb_text_inner\"><h1>Registration: Initial Meeting<\/h1>\n<\/div><\/div><div class=\"et_pb_divider_0 et_pb_divider_hidden et_pb_space et_pb_divider_position_top et_animated et_pb_module\"><div class=\"et_pb_divider_internal\"><\/div><\/div><div class=\"et_pb_text_2 et_pb_text et_pb_bg_layout_light et_pb_module et_block_module\"><div class=\"et_pb_text_inner\"><p>&nbsp;<\/p>\n<\/div><\/div><div class=\"et_pb_module et_pb_button_module_wrapper et_pb_button_0_wrapper\"><a class=\"et_pb_button_0 et_pb_button et_pb_bg_layout_light et_pb_module et_block_module\" href=\"https:\/\/www.digistore24.com\/product\/616173\">BOOK an initial consultation HERE<\/a><\/div><\/div><div class=\"et_pb_column_1 et_pb_column et_pb_column_1_3 et-last-child et_block_column et_pb_css_mix_blend_mode_passthrough\"><div class=\"et_pb_image_0 et_pb_image et_animated et_pb_module et_block_module\"><span class=\"et_pb_image_wrap\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/janert.info\/wp-content\/uploads\/2025\/06\/DSC_6863-scaled.jpg\" width=\"1707\" height=\"2560\" srcset=\"https:\/\/janert.info\/wp-content\/uploads\/2025\/06\/DSC_6863-scaled.jpg 1707w, https:\/\/janert.info\/wp-content\/uploads\/2025\/06\/DSC_6863-1280x1920.jpg 1280w, https:\/\/janert.info\/wp-content\/uploads\/2025\/06\/DSC_6863-980x1470.jpg 980w, https:\/\/janert.info\/wp-content\/uploads\/2025\/06\/DSC_6863-480x720.jpg 480w\" sizes=\"(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) and (max-width: 980px) 980px, (min-width: 981px) and (max-width: 1280px) 1280px, (min-width: 1281px) 1707px, 100vw\" class=\"wp-image-9706\" title=\"DSC_6863\" \/><\/span><\/div><\/div><\/div><\/div><div class=\"et_pb_section_1 et_pb_section et_section_regular et_block_section\"><div class=\"et_pb_row_1 et_pb_row et_block_row\"><div class=\"et_pb_column_2 et_pb_column et_pb_column_4_4 et-last-child et_block_column et_pb_css_mix_blend_mode_passthrough\"><div class=\"et_pb_text_3 et_pb_text et_pb_bg_layout_light et_pb_module et_block_module\"><div class=\"et_pb_text_inner\"><h2>Questionnaire for Initial Interview<span style=\"font-size: 16px;\"><\/span><\/h2>\n<\/div><\/div><div class=\"et_pb_text_4 et_pb_text et_pb_bg_layout_light et_pb_module et_block_module\"><div class=\"et_pb_text_inner\"><p>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.<\/p>\n<p>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.<\/p>\n<\/div><\/div><div class=\"et_pb_text_5 et_pb_text et_pb_bg_layout_light et_pb_module et_block_module\"><div class=\"et_pb_text_inner\"><div class='fluentform ff-default fluentform_wrapper_3 ffs_default_wrap'><form data-form_id=\"3\" id=\"fluentform_3\" class=\"frm-fluent-form fluent_form_3 ff-el-form-top ff_form_instance_3_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_3_1\" method=\"POST\" action=\"\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Questionnaire for Initial Interview<\/legend>        <div\n                style=\"display: none!important; position: absolute!important; transform: translateX(1000%)!important;\"\n                class=\"ff-el-group ff-hpsf-container\"\n        >\n            <div class=\"ff-el-input--label asterisk-right\">\n                <label for=\"ff_3_item_sf\" aria-label=\"Newsletter\">\n                    Newsletter                <\/label>\n            <\/div>\n            <div class=\"ff-el-input--content\">\n                <input type=\"text\"\n                       name=\"item_3__fluent_sf\"\n                       class=\"ff-el-form-control\"\n                       id=\"ff_3_item_sf\"\n                \/>\n            <\/div>\n        <\/div>\n                <input type=\"hidden\" id=\"__fluent_protection_token_3\" class=\"fluent-form-token-field\" name=\"__fluent_protection_token_3\">\n        <input type='hidden' name='__fluent_form_embded_post_id' value='7121' \/><input type=\"hidden\" id=\"_fluentform_3_fluentformnonce\" name=\"_fluentform_3_fluentformnonce\" value=\"be19d1dc98\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/7121\" \/><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_2'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text' id='label_ff_3_input_text'>First and last name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" data-name=\"input_text\" id=\"ff_3_input_text\"  aria-invalid=\"false\" aria-required=\"true\"><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_email' id='label_ff_3_email'>E-mail<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_3_email\" class=\"ff-el-form-control\" autocomplete=\"email\" data-name=\"email\"  aria-invalid=\"false\" aria-required=\"true\"><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_3'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_2' id='label_ff_3_input_text_2'>Street &amp; house number<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_2\" class=\"ff-el-form-control\" data-name=\"input_text_2\" id=\"ff_3_input_text_2\"  aria-invalid=\"false\" aria-required=\"false\"><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_1' id='label_ff_3_input_text_1'>ZIP CODE<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" data-name=\"input_text_1\" id=\"ff_3_input_text_1\"  aria-invalid=\"false\" aria-required=\"false\"><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_3' id='label_ff_3_input_text_3'>Town &amp; Country<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_3\" class=\"ff-el-form-control\" data-name=\"input_text_3\" id=\"ff_3_input_text_3\"  aria-invalid=\"false\" aria-required=\"false\"><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_4' id='label_ff_3_input_text_4'>I am a mother\/ father\/ caregiver (please specify in each case)<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_4\" class=\"ff-el-form-control\" data-name=\"input_text_4\" id=\"ff_3_input_text_4\"  aria-invalid=\"false\" aria-required=\"false\"><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_5' id='label_ff_3_input_text_5'>First and last name of the child + date of birth<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_5\" class=\"ff-el-form-control\" data-name=\"input_text_5\" id=\"ff_3_input_text_5\"  aria-invalid=\"false\" aria-required=\"false\"><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_description' id='label_ff_3_description'>Please describe your child, his or her STRENGTHS, and how he or she stays active so that I can get a better picture:<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description\" name=\"description\" id=\"ff_3_description\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_description_1' id='label_ff_3_description_1'>What are your child's INTERESTS\u2014how do they see the world?<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description_1\" name=\"description_1\" id=\"ff_3_description_1\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description_1\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_description_3' id='label_ff_3_description_3'>Please describe 1-3 problems that you as a parent\/caregiver are concerned about:<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description_3\" name=\"description_3\" id=\"ff_3_description_3\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description_3\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_description_4' id='label_ff_3_description_4'>Please name 1-3 questions for which you as a caregiver are looking for parent coaching:<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_3_description_4\" name=\"description_4\" id=\"ff_3_description_4\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description_4\" ><\/textarea><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_1\" ><p>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)<\/p><\/div><div class='ff-el-group ff-el-form-hide_label'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >Online<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_0660883642f34eaa0579a68c0e0f29d2'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"meistens online via Zoom und \u00fcber kurze Videos von unserem Kind, um gemeinsam mit den Eltern neue Wege zu finden, um meinem Kind zuhause selber zu helfen\"  id='checkbox_2_0660883642f34eaa0579a68c0e0f29d2' aria-label='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' aria-invalid='false' aria-required=\"true\"> <span>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<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-el-form-hide_label'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >Consulting<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_0337f821e131984f8a228cf694944773'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\" privat als unabh\u00e4ngige Beratung (Stundensatz: Euro 150, erm\u00e4\u00dfigt bei Jahrespaket u.a.), d.h. nicht von der Krankenkasse o.a. \u00fcbernommen\"  id='checkbox_1_0337f821e131984f8a228cf694944773' aria-label='Privately as an independent consulting service (hourly rate: 150 euros; discounted for annual packages, among other options), i.e., not covered by health insurance or similar programs' aria-invalid='false' aria-required=\"true\"> <span> Privately as an independent consulting service (hourly rate: 150 euros; discounted for annual packages, among other options), i.e., not covered by health insurance or similar programs<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-text-center ff_submit_btn_wrapper ff_submit_btn_wrapper_custom'><button class=\"ff-btn ff-btn-submit ff-btn-md et_pb_button ff_btn_no_style\" type=\"submit\" name=\"custom_submit_button-3_2\" data-name=\"custom_submit_button-3_2\"  aria-label=\"Send\">Send<\/button><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_3\" ><div class=\"p56997676 piotnetforms-submit piotnetforms-button-wrapper\">\u00a0<\/div>\n<p class=\"p79877576\">You can find more information about the contact form in the <a href=\"https:\/\/janert.info\/en\/privacy-statement\/\">Privacy policy<\/a>.<\/p><\/div><div 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