CPRT Parent Group – Inquire/Register

Interested in joining this group and/or learning more?

Please complete the below information and we will reach out to you shortly.

Child-Parent Relationship Training (CPRT), or Filial Therapy, is a well-researched parenting model in which parents learn and regularly practice effective, developmentally appropriate ways of communicating with your child. This training involves conducting a once-weekly special playtime with your child; these playtimes are 30 minutes in duration, occur at home, and utilize a specific toy kit that you must assemble or purchase. As part of your skill development, you will occasionally be asked to record this playtime and share with the group. If you anticipate being able to participate in this manner – and/or would like to learn more - please initial below and complete the remainder of this inquiry form.

Child's Full Name

Child's Age

School

Grade

Parent/Guardian's Full Name

Address

E-mail

Phone

Preferred Contact Method

Phone E-mail No Preference

Have there been any recent transitions or changes that have impacted you and/or your family? Do you anticipate any such transitions/changes in the future? Please describe:

Please list any mental health concerns, suspected and/or diagnosed (e.g., anxiety; depression; learning differences) for your child:

Please list any mental health concerns, suspected and/or diagnosed (e.g., anxiety; depression; learning differences) for caregiver(s):

Is anyone in your immediate family currently receiving mental health treatment (e.g., you, your child, etc)?

Yes No I'm unsure

What would you hope to get out of this group?

Is there any additional information you'd like to share with us?

How did you learn of this group?

CPRT Parent Group – Inquire/Register

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