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Application: Parent/Teen Harmonization Program

Transform parent-teen tension into deep connection—heal communication gaps, emotional wounds, and generational patterns.

This form is designed for parents and/or teens who are ready to heal through honest reflection, conscious communication, and energetic attunement. It’s optimized for Kajabi with optional fields for teen involvement.

Click the button below to start.

Start

Family Info

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Question 2 of 24

1. Your Full Name (Parent/Guardian)

Question 3 of 24

2. Phone Number

Question 4 of 24

3. City & Country

Question 5 of 24

4. Teen’s First Name & Age

Question 6 of 24

5. Would your teen like to participate in the program or stay in the background initially?

A

Yes, they want to be involved

B

No, they prefer to stay in the background for now

C

Not sure yet

Question 7 of 24

6. Are any other caregivers or siblings involved in this dynamic?

A

Yes

B

No

Understanding the Dynamic

.

Question 9 of 24

7. What are the core challenges or patterns in your current parent-teen relationship?

Question 10 of 24

8. Have there been specific triggering events, emotional ruptures, or communication breakdowns?

Question 11 of 24

9. How do you currently communicate with your teen when emotions run high?

(Select all that apply)
A

Open and calm conversations

B

Avoidance or shutting down

C

Yelling or frustration

D

Written communication (texts/letters)

E

Silent treatment or stonewalling

F

Other (please explain)

Question 12 of 24

9b. Other (please explain)

Question 13 of 24

10. What have you tried so far to repair or improve the relationship? (Therapy, coaching, boundary work, changes at home, etc.)

Your Vision for Harmony

Final step to complete Assessment

Question 15 of 24

11. What would a harmonized relationship with your teen look and feel like to you?

Question 16 of 24

12. What emotional qualities or communication skills do you want to cultivate between you?

Question 17 of 24

13. What are your teen’s strengths or hidden gifts that you’d love to see more fully expressed?

Question 18 of 24

14. What are the generational wounds or unconscious patterns you are committed to breaking?

Question 19 of 24

15. How ready are you to engage in this work, even when it gets uncomfortable? 

A

1 = Curious but unsure

B

5 = Feeling hopeful

C

10 = Fully committed and ready

Question 20 of 24

16. Has your teen expressed any desire (or resistance) toward healing or changing the dynamic?

A

Yes

B

No

Question 21 of 24

16b. If yes, please describe what they’ve shared

Question 22 of 24

17. Would you like a session just for your teen, just for you, or together as a starting point?

A

Just me (parent)

B

Just my teen

C

Both together

D

Unsure—open to guidance

Final Reflections

đź’–

Question 24 of 24

18. Is there anything else you’d like me to know about your teen, yourself, or your family?

Confirm and Submit