Parent Interview

This interview helps us understand your child's behavior patterns, what triggers them, and how your family is currently coping — so we can hit the ground running on day one.

Allow ~20 minutes — answer what you can, skip what doesn't apply.

HIPAA-compliant & confidential

Your Name *

Your Relationship to the Child *

Email *

Phone

Child's Name *

Child's Date of Birth

What is the main reason you're seeking ABA services right now? *

Describe the behavior(s) or challenges that concern you most.

When did these concerns first start?

Over the past few months, are these behaviors getting better, worse, or staying the same?

What motivates your child most? (select all that apply)

What strategies or approaches have worked well in the past?

What strategies have NOT worked or made things worse?

How are these behaviors affecting your family day-to-day?

e.g. Can't take trips to the store, siblings are affected, marital stress, can't have guests over

On a scale of 1–10, how would you rate your current stress level as a parent/caregiver?

Do you have a support system? (family, partner, other caregivers who help)

What are your top 2–3 goals for your child from ABA therapy? *

What does success look like to your family in 6 months?

Anything else you want our BCBA to know before the consultation?

Our BCBA will review your responses before creating your treatment plan. We typically follow up within 1–2 business days.

Parent Interview

About You & Your Child

Primary Concern

Aggression / Challenging Behaviors

Self-Injurious Behavior (SIB)

Tantrums & Meltdowns

Elopement / Running Away

Communication & Language

Social Skills & Play

Sensory Sensitivities

Routines & Flexibility

Daily Living Skills

School & Educational Setting

What Works (& What Doesn't)

Family Impact & Support

Goals & What Success Looks Like