Parent Brainstorming Form and Questionnaire

This is for students who may need residential treatment or a therapeutic summer experience:

Common ground is critical when you are making a change in your child’s life. Please discuss and return with areas of agreement and disagreement that will enable me to help you set priorities. Please fill out the form below, scan to jeanette@jeanettespires.com, or print it out and fax to 847-234-7227, or mail to 111 Fallstone, Lake Forest IL, 60045.

Name *
Name
Could include respect for authority, addictive behaviors, anger management (verbal or physical), isolation, school performance, etc.
Often a couple’s areas of disagreement come from the methods they have used in attempting to correct behaviors. These areas of disagreement often create a power play for the child, who can use your own behaviors against you in trying to divide and conquer.
Student DOB *
Student DOB
Parent Name *
Parent Name
Day Phone *
Day Phone
If you have behavioral concerns, it is often helpful to both you and me for you to prioritize them in order of importance.