Name
*
First Name
Last Name
Email
*
Phone Number
*
(###)
###
####
Preferred method of communication
Relationship to the Little
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Parent
Guardian
Caregiver
Foster
Other
Little's Name
*
Pronouns
Age
*
Does your Little attend school or daycare? If so, where and what kind of environment (public, Montessori, homeschool, etc.):
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How would you describe your Little’s personality in three words?
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What do you love most about your Little right now?
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Are there any current struggles, transitions, or behaviors that feel challenging?
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Has your child received any formal diagnoses, evaluations, or IEP services?
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How does your Little typically respond to big feelings (e.g., frustration, sadness, overwhelm)?
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Have you noticed any patterns that concern you (meltdowns, withdrawal, aggression, etc.)?
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What kinds of strategies have you tried that seemed to help — or didn’t?
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Is your Little sensitive to sensory input (e.g., sound, touch, transitions, lights, etc.)?
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Do they enjoy movement, music, drawing, or calming activities?
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Are there moments when your Little really lights up? What tends to bring them joy or peace?
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What do you most hope for your Little in this season? (emotionally, socially, or overall)
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What type of support are you interested in?
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Social-Emotional Coaching
Brave Hearts Tutoring
Both
Unsure
Preferred session format:
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In-Person
Virtual
Community-Based
What days and times generally work best for your family?
*
Is there anything else you’d like me to know about you and your Little before we connect?
