Either complete and submit the Family Questionnaire using the following online form, or download and print the attached Word or PDF documents and submit them to Emory by email, snail mail, or in person.

Download Family Questionnaire

Online Family Questionnaire

Thank you for taking the time to answer these questions.Your answers will save us valuable session time and improve my ability to be helpful to you. I assure you that brief answers are fine, but longer answers are also useful if you wish to provide more detail.

Who is filling out this questionnaire (alone or together)?

I invite every parent or person acting as a parent to fill out this questionnaire before we meet. Just as looking with two eyes improves depth perception, reading more than one questionnaire improves my view of your family. If your partner does not fill out their own questionnaire, please ask them to answer questions 42-48 (about the family they grew up in) separately.

Your Name(s): (optional, leave blank for anonymous submission)

Your Email: (optional, leave blank for anonymous submission)

  1. Of all the good things that could be said about your family, which one would you say is probably the most true and admirable?

  2. What are the names and ages of each member of your family, including yourself?

  3. What would you consider to be the most important things I should know and appreciate about each individual person in your family (including yourself)?

  4. How do you see your family’s most positive qualities making it possible for you all to function better and deal with life’s big and small challenges?

  5. Among all of your good qualities as a parent, which one would you say is probably your most admirable quality as a mother or a father?

  6. What do you consider to be your main challenges with each of your children?

  7. What is the most important problem you would like my help with?

  8. Is this a problem you notice with just one particular child? Who?

  9. Please give me a picture of this problem. Specifically, it would be helpful if you would describe:

    1. What happened just before the problem occurred?

    2. What happened that made you realize that this was a problem?

    3. What did you and/or other adults do in response?

    4. How did your child respond to you then?

  10. Why do you suppose this problem hasn’t become worse than it already is?

  11. What have you noticed seems to improve the situation when the problem occurs?

  12. What have you noticed seems to make the situation worse when the problem occurs?

  13. Does this particular problem show up only at home, or does it also appear outside of the home (for example, at school, with friends, in public)?

  14. If the problem you have been describing just disappeared right now, how would things be different in your family?

  15. Did your child, or did your children, come to you through birth or through adoption?

  16. If your child, or your children, were born to you, what were the pregnancies like?

  17. If your child, or your children, came to you through adoption, how old were they at the time? Where were they born?

  18. If you have more than one child, how are the children different from each other? What characteristics do they share in common?

  19. Which child in the family is the most like you? How is he or she like you? What do you particularly enjoy about him or her?

  20. Are you parenting alone or with a partner? If you have a partner and if you are the only one filling out this questionnaire, please tell me about
    your partner.

  21. Which child is most like their other parent? How are they like their other parent? What does the other parent especially enjoy about them?

  22. What is the relationship like between you and your partner? How do you handle disagreements? What do you usually disagree about?

  23. If you are no longer living with or married to your partner, is there another adult co-parenting with you in your home?

  24. Are there stepchildren or foster children in the family? Please tell me about them.

  25. Who makes the big decisions for your family? Who makes the little, day-to-day, decisions for your family?

  26. Which parent is most worried about the children? In what way?

  27. What is your philosophy about the best way to teach children?

  28. What is your philosophy on the best way to respond to children’s misbehavior?

  29. On what topics related to parenting situations do you and your partner have different opinions? What happens when you have different opinions on
    how to handle parenting situations?

  30. What other adults are important in the child’s life? In what way?

  31. What other children are important in the child’s life? In what way?

  32. Do you or any family members use alcohol or recreational drugs? To what extent? How does this affect the family? How does the child/how do the
    children react to the adult’s use of drugs or alcohol? How do the adults react to the child’s use of drugs or alcohol?

  33. If you could change anything about your family, what would you change?

  34. What activities are your children involved in outside of school? How much time do they give to each activity?

  35. Describe the routine happenings on a typical weekday for your family.

    1. Morning

    2. Afternoon

    3. Evening

    4. Weekends

  36. What are your child’s/children’s responsibilities?

    1. For waking up in the morning.

    2. For getting dressed, teeth brushed, hair fixed in the morning?

    3. For getting their own breakfast and/or lunch ready?

    4. For doing homework?

    5. For getting ready for bed at night?

    6. For picking up after themselves, cleaning their room?

    7. For household chores that benefit everyone (examples: setting the table, preparing food, cleaning up family areas)?

    8. For taking care of pets?

  37. What meals does your family eat together? How often? What are mealtimes like for your family?

  38. Does your child/do your children have trouble going to bed, turning out the lights, getting to sleep, or sleeping through the night? Is there a
    problem with bed-wetting? Do they have nightmares or bad dreams? How do you help your child when they have any of these problems?

  39. Does your child have a regular bedtime? How much sleep does each child get every night, on average?

  40. What traumatic events have occurred during your child or your children’s lives? How did your child or your children react to the trauma? What was
    done to help your child or your children cope with any trauma they experienced?

  41. What are your hopes and dreams for your child’s/children’s future?

  42. What is your greatest fear for your child’s/children’s future?

  43. Please tell me a little bit about the family you grew up in:

    1. What were your parents like?

    2. How many brothers and sisters did you have?

    3. What was your birth order position?

    4. What was your parent’s discipline style?

    5. As a child, what were you known for in your family—positively and negatively?

    6. What were the most important values in your family when you were growing up?

    7. When you were young, do you remember thinking to yourself, “when I am a parent, I’m going to do things very differently”? What was it you
      planned to do?

  44. How does your current family resemble the family you grew up in? How is your current family different from your family you grew up with?

  45. How does your parenting resemble that of your parents? How is your parenting style different from theirs?

  46. What else is important for me to know and appreciate about your family?

Thank you very much for answering all of these questions — your responses are very helpful.