Coaching Application - Dr. RJ

Parent's Name*

First Last

Phone*

Email*

Child's Name*

Child's Age*

Child's Gender*

Share your child's story. Write any information that will help Dr. RJ understand your child.*

What are your biggest fears as it relates to your child's issues?*

How much stress are these issues are causing you each day? (1- Not Stressed, 10-Extremely Stressed)*

What areas of your life are negatively impacted by the issues you see in your child?*

Please list "other" areas of your life negatively impacted

What is something that your child can change today that would improve their quality of life?*

Share a hypothetical example of what it would look like if that one change (from previous question) happened.*

What have you tried so far to correct those issues? What worked? What did not work?*

Have you tried therapy or counseling?*

Why or why not did you choose therapy or counseling?*

What is the one change that you would like to see in your child after coaching with Dr. RJ?*

What are you willing to change about yourself during this program?*

Would you like to have parent coach throughout the program?*

Have you mentioned this program to your child (we recommend that you do not)?*

If yes, describe their reaction

How excited do you feel your child will be about life coaching?*

How likely is it that you child will be defiant or resistant to the program?*

If you answered “very likely,” would you like to learn about Dr. RJ's Coach Your Teen™ program for parents?

What would be different in your life if your child no longer struggled with those issues?*

What would be different in your child’s life if they no longer struggled with those issues?*

How important is it for your child's issues to be corrected right now? (1 - not really important right now, 5 - extremely important right now)*

Dr. RJ’s life coaching programs are highly successful. What would need to happen in your child for you feel that his program is a success?*

As of today, how much have you invested in your child's mental health?*

When customizing a program for your child, which component is the most important:*

Do you fully understand Dr. RJ’s success formula (found at www.drrjjackson.com/testimonials)

Have you listened to at least one episode of Dr. RJ’s podcast (found at www.ateensperspectivepodcast.com)

Have you read testimonials from parents who have completed the program (found at www.drrjjackson.com/testimonials)

Please share any final thoughts

Teen Life Coaching Consultation