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Get clarity, support and real solutions for your co-parenting challenges,
No pressure just a space safe to talk.

Co-Parenting Coaching Session - Parent Questionnaire

Basic Information

Full Name *

Preferred Name *

Email *

Phone *

City *

Family Background

Number of children *

None

other

Children’s Ages & Birthdays

First Child Birthday *

Second Child Birthday

Third Child Birthday

Fourth Child Birthday

Living Arrangements: *

Full-time with me

Part-time (shared custody)

Primarily with the other parent

Other

How long have you been co-parenting? *

<1 year

1-3 years

3-5 years

5+ years

Co-Parenting & Communication

Describe your co-parenting relationship: *

Cooperative

Neutral

Difficult

High-conflict

Main communication method: *

In-person

Phone

Text

Co-parenting app

Other

Biggest challenges? (Check all that apply) *

Communication

Different parenting styles

Scheduling

Stress

Legal issues

Blended families

Other

Have you been through mediation? *

Yes

Your Goals for Coaching

What do you hope to gain? (Check all that apply) *

Better communication

Conflict resolution

Boundaries & roles

Emotional support

Parenting consistency

Other

Confidence in co-parenting (1 = not confident, 10 = very confident): *

Specific topics/concerns you’d like to discuss? *

Final Thoughts

Open to additional coaching sessions? *

Yes

Maybe

Anything else you’d like me to know? *

ChurmellMitchell

Court-informed co-parent support to help you communicate safely, prepare for mediation, and protect your child's emotional health.

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Supporting parents nationwide & internationally for over 9 years.

BOOK FREE 15 MINUTES SESSION CONVERSATION THAT COULD SHIFT EVERYTHING

Get clarity, support and real solutions for your co-parenting challenges,No pressure just a space safe to talk.

Co-Parenting Coaching Session - Parent Questionnaire

Basic Information

Family Background

Co-Parenting & Communication

Your Goals for Coaching

Final Thoughts

ChurmellMitchell

Resources & Store

Connect

Get clarity, support and real solutions for your co-parenting challenges,
No pressure just a space safe to talk.