Parent Smarter, Not HarderEnrollment Meeting Sign-Up Name * First Name Last Name Email * Subject * Phone * (###) ### #### Caregiving Role * (e.g., mother, father, stepparent) How many children are you parenting? * Professional role(s) * List all job titles here, including Domestic CEO! Ages of children * Click all that apply 0-2 2-5 6-10 11-13 14-18 How would you describe your main parenting challenges right now? * What do you hope to get out of participating in the Parent Smarter, Not Harder program? * Will you be seeking guidance for parenting a child with a neurodevelopmental (ADHD, autism) or mental health diagnosis (anxiety, depression)? * Yes No If yes, is that child receiving some level of treatment (therapy and/or medication)? Yes No Will you be able to commit to meeting for an hour for six consecutive weeks during daytime weekdays in September and October? * Yes No Where do you live? * Pacific Time Zone Mountain Time Zone Central Time Zone Eastern Time Zone Outside U.S. What else would you like me to know before scheduling our call? Thank you for filling out the questionnaire. I will be in touch soon to schedule that appointment with you via email. Talk soon!
