Client Profile

Full Name

Email

Phone

Birthday

Month

Day

Year

Address

Spouse/Partner

Anniversary

Month

Day

Year

Children

Pets

Occupation

Employer/Company

Education

What is your relationship with ADHD?

Diagnosed

Undiagnosed but suspected

Friend/family of someone with ADHD

ADHD Curious

Other

Reason for contacting me

What do you want me to know about you?

Referred by

As an ADHD coach, I am not a licensed therapist or medical professional. I do not diagnose, treat, or prescribe medications for ADHD, mental health conditions, or psychological issues. My role is to provide support, strategies, and guidance to help you navigate life with ADHD. For medical or psychological concerns, please consult a qualified healthcare provider.

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