Parent Survey Quiestionnaire

Baker Strategy Questionnaire for parents/collaterals.

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Your role

During the past six months, how often has the other parent / primary caregiver engaged in the following behaviours?(Required)

	Never	Rarely	Sometimes	Often	Always
Spoke negatively about me to our child - bad-mouthing.
Interrupted, blocked, or ended my phone or video calls with our child.
Scheduled activities that made the child miss my contact time.
Hid, threw away, or refused to deliver cards, gifts, or letters from me.
Told our child I am dangerous, untrustworthy, or mentally unstable.
Made the child feel he/she had to choose between parents.
Said or implied that I do not really love the child.
Shared adult legal or financial details to turn the child against me.
Pressured the child to reject or confront me directly.
Asked the child to obtain information or documents about me - spying.
Instructed the child to keep secrets from me.
Encouraged the child to call a step-parent, eg. Mom or Dad.
Addressed me by my first name when speaking with the child.
Changed or tried to change child surname to exclude mine.
Undermined my household rules or authority in child presence.
Tried to make the child emotionally dependent by over-indulging or favouring.
Withheld important information like school events, medical appointments, etc.

Total Score

Average score