Parenting Check-In Survey Form
Please take a few minutes to share your recent parenting experiences. Your responses help us understand and support your journey.
How would you describe your overall mood as a parent this past week?
*
Very positive
Somewhat positive
Neutral
Somewhat negative
Very negative
How often did you feel supported in your parenting role this week?
*
Always
Often
Sometimes
Rarely
Never
Please rate your current level of stress related to parenting.
*
Very low
1
2
3
4
5
6
7
8
9
Very high
10
1 is Very low, 10 is Very high
How satisfied are you with your work-life balance as a parent?
*
1
2
3
4
5
In the past week, how many quality moments did you share with your child(ren)?
*
None
1-2
3-5
6-10
More than 10
What parenting topics or challenges would you like more support with? (Select all that apply)
Discipline & boundaries
Communication with children
Managing routines
Self-care for parents
Balancing work and family
Other
Please indicate your agreement with the following statements about your parenting experience this week.
*
Rows
Strongly disagree
Disagree
Neutral
Agree
Strongly agree
I felt connected with my child(ren)
1
2
3
4
5
I managed parenting challenges effectively
6
7
8
9
10
I had enough time for myself
11
12
13
14
15
I felt confident in my parenting decisions
16
17
18
19
20
What is one thing that went well in your parenting this week?
Is there anything you would like to share or suggest to improve your parenting experience?
Submit Survey
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