Counseling - Teen Confidence Clarity Session

Please complete the form before our Clarity Session to get a better understanding of your goals and dreams.

What is your name? *

What is your email address? *

What is your phone number? *

List the challenges you are currently facing with your teen(s)? *

What are some challenges you are facing with your relationship with your teen(s)? *

What are some specific result you would like to see with you and your teen(s) in 3months? The next six months? One Year?*

Do you have set goals for your teen(s), if so, please list short term and long term goals? *

What are the major obstacles or blocks that have previously prevented your teen(s) from achieving this goals? *

Where do you see your teen(s) in 5 years?*

What would it mean to you, if your teen(s) achieved these goals? How would it impact your life?*

Is there a specific aspect of your teen(s) life that you need support with?*

Please share your family background/lifestyle?*

Anything else you would like to share? *