Name *

First Name

Last Name

Phone

(###)

###

####

Address

Where do you call your (work) home or home home?

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What do you struggle with?

These are challenges that I've heard mentioned the most by clinicians with ADHD and/or executive functioning challenges. Do you struggle with any of them?

-making time for paperwork

-finishing paperwork

-keeping up with paperwork

-messy desks

-organizational challenges

-facing stigma around taking medication

-sleep difficulties

-balancing business and family relationships

-feeling behind on clinical tasks

-deciding if accommodations are right for you

-being late to client appointments

-ending on time

How ready are you to join on in? *

I'm ready! I can't wait!!! Sign me up!

I'm not sure. Can we talk on the phone?

I'm still not sure. Can we email a bit?

Yes. I think this is a good idea. I'm in.

Have you been diagnosed with ADHD? *

Which category to you fit in?

Yup. With ADHD, any type.

Yes. With ADD, when that was the name of ADHD, inattentive type.

Nope. But I SO have it.

Nope but I struggle with Executive Functioning stuff.

Nope, but my friend does but they're too nervous to email.