Questionnaire - Parenting

PARENTING QUESTIONNAIRE

Date *

* Indicates required field

Name *

First

Last

Email *

How did you hear about me? *

If on Facebook, please check all that apply *

Through an ad On a friend's wall In a group Continuum Concept related

If in a Facebook group, which one? *

What country/state/province do you live in? *

Names and ages of your children *

Please tell me about yourself and your family *

What led you to contact me? *

What are the top 3 challenges you're experiencing in your family? *

What is your vision for your family? *

What is in your way of living this vision? *

On a scale of 1 to 10 (10 being highest,) how committed are you to achieving this vision? *

Where would you like to be in 3 months? *

Is there anything else you'd like me to know? *

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There is no single effort more radical in its potential for saving the world than a transformation of the way we raise our children.
Marianne Williamson

PARENTING FOR WHOLENESS