Join us for our next parent cohort!

Parent/Caregiver First Name

Parent/Caregiver Last Name

Email

Is this your first time attending?

Yes

No

Phone

Child Information

Child's Age

Biggest Challenge Right Now - In 2 - 3 sentences, what's the most challenging behavior you're dealing with daily?

Program Fit Assessment

Have you tried behavior strategies before?

Yes, many different approaches

Yes, a few things

No, this is new to us

Not sure what counts as a "strategy"

What is your main goal for this program?

Stop challenging behaviors immediately

Understand why behaviors happen

Learn long term strategies

Get support from other parents

Which times work best for you?

Tuesdays - 10:00 - 11:00 am (October 7, 14, 21, & 28)

Thursdays - 7:30 - 8:30 pm (October 2, 9, 16, and 23)

Investment and Insurance

This 4 - week cohort program is $197. This:

Fits our budget perfectly

Is what we expected for this type of program

Is outside of our current budget

We are unsure about the investment

Insurance Coverage

We have insurance that may cover parent training (we'll help verify)

We don't have insurance coverage

We're not sure about our coverage

We prefer to pay out of pocket regardless

If you have insurance, please list your Primary Insurance Provider

Is your child enrolled in ABA?

They are currently receiving direct ABA therapy.

They are on the waitlist for direct ABA therapy.

We aren't seeking direct ABA services at this time.

Commitment & Availability

Attendance Commitment

Yes, I can commit to all 4 weekly sessions

I might miss 1 session

I'm not sure about my schedule yet

I have significant scheduling constraints

What made you interested in this program?

How did you hear about us?

Join us for our next parent cohort!

Child Information

Program Fit Assessment

Investment and Insurance

Commitment & Availability

From chaos to clarity. We are here for you.

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