Caregiver 1 Name (First & Last)
Caregiver 2 Name (First & Last)
Email
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Phone
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What’s it like to be you — as a parent, as a person? What comes easily to you in daily life or parenting? What tends to feel harder or more draining?
What are some of your natural strengths or ways of being that help you show up for your child? And what areas (in parenting or life) tend to feel more tender, tiring, or unknown?
How do you tend to respond to stress, chaos, or challenge — emotionally, physically, or otherwise? Do you shut down, get revved up, stay steady — or something else? What helps you feel safe, grounded, or capable in those moments?
How do you like to be supported? What’s most helpful for you when navigating new challenges — practical tools, deep understanding, steady encouragement, clear plans, or something else?
Child's Name & Age
What do they love? (Activities, people, types of play, environments, etc. — where do they light up?)
What kinds of things throw them off or cause them stress? (Specific situations, transitions, sensations, sounds, or interactions?)
How does your child seem to experience the world through their senses? (Do they crave movement, touch, noise — or shy away from stimulation? Are there textures, sounds, or sensations they seek or avoid?)
What rhythms seem to support them best? (Are there routines, times of day, or rituals that seem to anchor or stabilize them?)
When do they seem to feel most safe, grounded, or connected? (Think: snuggling after a long day, quiet play, time in nature, consistent routines, etc.)
How do they seek connection? When they want closeness, how do they ask for it? (e.g., physical touch, conversation, proximity, shared play, needing help they could do on their own)
How expressive are they with their feelings and needs? (Do they tend to hold things in, communicate openly, or show emotions through behavior?)
When do you notice them becoming dysregulated — tense, overwhelmed, or withdrawn? (What are the signals they give you — in body, voice, mood, or behavior?)
How do they return to regulation after a hard moment? (What helps them come back to center — on their own or with your support?)
What are you still figuring out? Are there areas where you feel like you don’t quite “have the manual” yet? Anything that feels puzzling or hard to read?
What do you love most about their personality? (Is there something about the way they think, feel, express themselves that feels uniquely them?)
What tells you they’re thriving? (What do you notice in the little moments that says: “they’re okay”?)
Child's Level of Physical Activity:
Child's Biological Rhythms (regularity of internal drives such as wake times, sleep, eating, toileting, etc.):
Child's Level of Sensitivity (to environmental factors such as sound, light, touch, smell, taste, etc.)
Child's Intensity of Emotional Responses (to changes, environment, etc.)
Child's Level of Adaptability (to change, transitions, or new situations)
Child's Level of Approachability or Withdrawal (to new people, environments, changes, situations, things, etc.)
Child's Level of Persistence (with new or challenging tasks)
Child's Level of Distractibility (to environmental factors such as sound, light, touch, smell, taste, etc.)
Child's Mood (overall tone of feelings, interactions and behaviors, etc.)
Additional Parent Notes (if needed)