Surrey Elder Mediation Services, Family Mediator, Seniors

Vancouver Step / Blended Family Survey

Q1
1. I am	Yes	No
1. Step Mother
2. Step Father
3. No Biological Children of my own
4. Have Biological Children

Q2
2. As a couple we seem to argue about the following topics:	Yes	No
1.Different Parenting Styles
2. Financial Issues
3. Communicating With Each Other
4. Communicating with Step Children
5. Other

Q3
3.The Children's other biological parent causes problems within our family such as:	Yes	No	N/A
1. Telling the chilcren they don't need to listen to the step parent.
2. Dissapointing the children by being inconsistant with visits.
3. Controling my spouse.

Q4
4. As a Step Family, we need help in the following areas:	Strongly Agree	Somewhat Agree	Somewhat Disagree	Strongly Disagree
1.Eliminate stress when we try to do things as a family.
2. Improve communication between the adult and the children.
3. Strategies to improve our "Couple" relationship.
4. Other

Q5
5. In terms of products or services being developed, the following are of interest to help improve our Step Family situation;	Yes	No
1. Telephone mediation for bio and step parent
2. Teleseminar: small education segments presented over the telephone.
3. Webinar: video education over the computer
4. Four Week Group sessions: Utilizing teleseminar and webinar
5. Electronic Newsletter

Q6
6. As the Biological Mother I am concerned with the following:	Strongly Agree	Somewhat Agree	Somewhat Disagree	Strongly Disagree
1.Step-Father not taking an active roll with my child.
2. Step Father trying to Discipline my child too much.
3. Step Father appears jeolous of me and my children.
4. Other

Q7
7. As the Biological Father I am concerned with the following:	Strongly Agree	Somewhat Agree	Somewhat Disagree	Strongly Disagree
1.Step-Mother feeling that I don't discipline my children enough.
2. Step Mother commenting on feeling left out of our family.
3. Step Mother angry with the visitation schedule.
4. Step Mother wants me to spend less time with my children and more time with her.

Thank you for completing the Step / Blended Family Survey. Kindly fill out the following email form and you will receive
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Step / Blended Families

My role as a Family Mediator and Step Family Coach is to be a neutral third party who provides information to help the family members.

Step Family Mediation

Step Family Mediation uses a collaborative mediation model along with an educational component to address issues that are very common for Step Families.