Parent Pal Online Booking

Let’s Prepare for Your First Session

If you have any questions or need assistance please contact us at (301) 781-8189 or emailus@parent-pal.com

Before your first Parent Pal session, please complete this brief contact form so we can tailor our support to your family. You can also complete the form online, download it, and send it to emailus@parent-pal.com

Are there any current court orders that limit or govern your child’s contact with either parent or interactions between parents? (For example: an Order of Protection involving the child or a parent, court-ordered supervised visitation, or similar restrictions.)

Because court-ordered parenting arrangements can affect scope of coaching, we may not be able to support parenting or parent–child interaction topics right now. Please contact us so we can explore next steps.

Name of Parent(s), Grandparent(s), or Caregiver(s)*

First NameMiddle NameLast Name

Phone or Cell Number*

Email

example@example.com

Choose a time that works for you. Click the up and down arrows to change the month.

Schedule a Free Parent Support Call (You’ll complete and review important information before submitting (See under payment details).

Parent Pal Sessions: Getting started is easy

Parent Pal 1-Hour SessionIf you need to cancel, Parent Pal provides a full refund for cancellations made at least 24 hours in advance.

$45.00

Parent Pal 45-Minute SessionIf you need to cancel, Parent Pal provides a full refund for cancellations made at least 24 hours in advance.

$35.00

Parent Pal 30-Minute SessionIf you need to cancel, Parent Pal provides a full refund for cancellations made at least 24 hours in advance.

$25.00

Parent Pal Monthly CoachingIf you need to cancel, Parent Pal provides a full refund for cancellations made at least 24 hours in advance.

$85.00

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

How would you like to meet with your Parent Pal?

ZoomTelephoneFacebook MessengerIOS Facetime

Zoom links and phone instructions will be sent after scheduling.

Child/Children/Teen's relationship to you:*

Reason(s) for seeking Parent Pal Advice and Coaching*

Does the child/children/teen(s) have a history of problematic behaviors (e.g., oppositional defiance, backtalk, peer pressure, etc.)? If so, please explain.

Parent Pal provides coaching and educational support only. These services are not medical, psychological, or therapeutic treatment and do not replace care from licensed professionals.

Parent Pal coaches do not assess, diagnose, treat, or prevent any medical or mental health condition. For emergencies, contact a licensed healthcare provider or emergency services immediately. Parent Pal operates as a program of a Limited Liability Company (LLC). Participation is voluntary and parents/caregivers remain responsible for decisions regarding their family and child.

All consultations are private and confidential as permitted by law. Parent Pal may keep notes for internal use. We may limit confidentiality to meet safety or legal reporting requirements.

Parent Pal does not accept private insurance.

I have read, understand, and agree to the above disclaimer and terms.I understand that Parent Pal does not provide emergency services and that I am responsible for seeking appropriate professional help when needed.