Thank You For Choosing To Work With Us!

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This questionnaire will help us serve you better and allow us to offer the best support in your parenting

Email *

First and Last Name *

Phone number *

State/Country-Where You Live *

Company Name (if applicable)

What Do You Hope To Gain From Parent Coaching? *

1-On-1 Tips and Strategies to Help Me With My Children

A Group of Like-Minded Parents Where We Can Hold Each Other Accountable And Grow Together

A Community of Like-Minded Parents Where We Can Develop Friendships and Share And Support Each Other

A Class or a Course Where I Can Learn Best Practices on Parenting

Other:

Which Best Describes You? *

I am a Mom/ Single Mom/Working Mom

I am a Dad/Single Dad/Working Dad

I am Married. I Parent With My Spouse

I am a Grand-parent, Step-Parent, God-Parent, etc. and I'm Raising Children

I am a New Mom. I Have a Newborn

I am an Empty Nester. My Children Are Grown, But I Still Help or Support Them

I am a Parent and I'm Trying to Re-establish Relationship with My Children

My Organization Offers Parental Support and Resources

Required

How Old Are Your Children?

Birth to 5 Years Old

6-12 Years Old

13-19 Years Old/Teens

Young Adult/Adult

What Other Parenting Support or Resources Have You Tried In the Past? What Were The Results?

If There Were One Parenting Challenge You Did Not Have To Worry About Anymore, What Would it Be? *

How Did You Hear About Us? *

I Have Worked With Eric G. Graves and/or His Team Before

Referred By A Friend

Referred By A Family Member

Social Media

Other:

Required

Your Journey to Becoming A Confident Parent Can Begin Today. Do You Need to Obtain Approval or Support Before Investing or Starting Our Parenting Coaching Services?

Yes

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At This Time, Which Level Are You Prepared to Invest in Parent Coaching? Eric and His Team Offer Personal and Professional Coaching, Courses and Community Programs ranging from $300 to $6000 to Serve Clients. Hourly Rates Start at $150 for Coaching. (As With Other Professional Development Services Which Help Your Business Grow, Coaching May Be Tax-Deductible.) * *

$150 per session (Coaching Only)

$300 (Group Coaching Only)

$500 (Parent Accountability Support System)

$1500 (Parent All-Access Empowerment Membership)

$3000 (Full and Complete Parent Coaching Package; Calls, Check-ins, Assignments, Community)

$6000 (Hiring Eric to Speak at Your Virtual or Live Event)

If After Our 30 Minute Confident Call We Both Agree We Are A Great Coaching/Client Match, Are You Prepared to Make the Investment You Indicated Above at This Time? * *

Yes

When Is the Earliest We Can Speak to You By Phone? *

I Can Talk Today

I Can Talk Tomorrow

I Can Talk Later This Week

Send me a copy of my responses.

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