Quiz

Hi!

Please fill out this quiz so that we can find out how best to help.

We want to learn more about you & your family.

We are here to listen.

About Me

Name

There are things that I am good at.YesSort ofNo

There are things I do that I really enjoy.YesSort ofNo

I have people in my life who love and care about me.YesSort ofNo

The grown-ups in my life are able to take good care of me.YesSort ofNo

I am worried about 1 or both of my parents.YesSort ofNo

My parents talk to each other about me.YesSort ofNo

Both of my parents think that the other parent takes good care of me.YesSort ofNo

I know that there are others who feel the same way I do.YesSort ofNo

I know what to do when I am feeling new or unusual things.YesSort ofNo

There is a grown-up that I can talk to (about my feelings) who isn’t my parents.YesSort ofNo

I have the right amount of choice about what happens in my life.YesSort ofNo

I get to see both of my parents as much as I want to.YesSort ofNo

I can talk to both of my parents about the other parent.YesSort ofNo

I see enough of both of my parents on birthdays and Christmases.YesSort ofNo

I know other children whose parents are also splitting up.YesSort ofNo

I understand why my parents are splitting up.YesSort ofNo

I can ask my parents questions and they will tell me what I need to know (but not more).YesSort ofNo

I still get to do some of the things that I used to do before my parents split up.YesSort ofNo

I would like more of…

I would like less of…

I am happy for you to collect, keep and use the answers I have given to these questions. *YesWe will only use this information when working with you.

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