Free 1-on-1 Clarity Consult

Thank you for choosing a 1-on-1 Clarity Consult. To make the best use of our time together, please fill out the questionnaire below prior to our scheduled appointment. You’ll find questions related to your health, daily habits, stress levels and parenting.*

*Note: I am not a therapist or medical professional. Their job is to diagnose and prescribe solutions. I am a Parenting Skills Coach, and a Personal Trainer. My job is to identify  and clarify your goals, and create strategies to help you reach them. I look forward to working with you!

The purpose of the questions is to save some time. We’ll have 45 minutes, but believe me, it will go by quickly! Some questions of a more personal nature are not required, however, the more you share, the more you will get out of our session. Your privacy will be respected and protected.

Street, City, County, State/Province, Zip Code, Country
All answers are correct.
First names only, genders, ages, relationship to you
Check all that apply.
Pick the ONE that best describes you over the past month.
Pick the ONE that best describes your child over the past month.
Check all that apply.
Pick one.
Need Help . . . . . . . . . . . . . . . . Managing . . . . . . . . . . . . . . . . . . I Got This!
Incremental . . . . . . . . . . . . . . . . Mixture. . . . . . . . . . . . . . . . . . Final
Internal Recognition . . . . . . . . . . . . . . . . . . . . . External Recongition
Progress . . . . . . . . . . . . . . . . Equally . . . . . . . . . . . . . . . . . . Completion
Pick one.
Note: This has nothing to do with being bold or shy.
Pick one.
Choose all that apply.
0% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100%
0% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100%
0% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100%
0% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100%

Let’s TACKLE IT Together

Ask Deborah a Question

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