Private Consulting Form

Disclaimer: Peace at Home Parenting Solutions experts provide parenting education only and are not acting as therapists or clinicians. Experts may take notes on your conversations as a way of maintaining continuity between sessions. These are not medical notes and are not covered under HIPAA law. Any notes will be kept confidential except in the case of a court order. Peace at Home Parenting Experts are mandated reporters in the event of suspected abuse or neglect of a minor.

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Name (Nombre)(Required)
Choose your session (Elija la sesión)(Required)
Session Availability (Disponibilidad)(Required)
Please select all available times you can be available (Seleccione todos los horarios disponibles )
Age(s) of Children(Required)
check as many as needed
Disclaimer Consent(Required)
Peace at Home