Productivity Playground: Adult ADHD Coaching Group
Please fill in the form below so we can identify if you are a good fit for the group!
Name:
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First Name
Last Name
E-mail Address:
Phone Number:
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Area Code
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Address:
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Street Address
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City
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Postal / Zip Code
How were you referred to us?
Online Search
Twitter
Provider Referral
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Others (if referred by a provider tell us who) :
What motivated you to join the group?
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What are your goals? What would you like to accomplish through coaching?
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What kind of things do you struggle with?
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Time Management
Task Management
Productivity
Procrastination
Difficulty Finishing Things
Impulsivity
Focus
Clutter
Emotional Regulation
Sleep
Connection & Relationships
Other
Have you ever participated in a coaching group before? What was your experience? If you haven't what would you like to experience?
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Are you open to feedback and committed to taking action to improve your life?
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YES, I want to feel more successful!
Not Really, I just want validation.
Other
What has gotten in the way of progress before?
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What is different now?
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Why is achieving your goals (from above) important to you at this time?
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What are your strengths? And how do you see yourself contributing to others in the group?:
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Are you open to viewing your experience from a place of empowerment rather than blaming others, open to new approaches and willing to take action to change your results?
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YES! I AM OPEN AND WILLING TO TAKE OWNERSHIP FOR MY RESULTS!
NO. I AM STUCK IN A VICTIM MINDSET AND I RATHER BLAME OTHERS THAN CHANGE MYSELF
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