FOCUS Family Application

FOCUS Family Intensive Application
I am thrilled you are looking for a coach. Kudos for getting your family support.

I use a short application before scheduling a discovery call so we can both be sure it’s a good fit. Your answers help me understand your goals, challenges, and needs so our time together is focused, meaningful, and productive.
Name

First NameLast Name
Email
example@example.com
What is your relationship to ADHD? (officially or self diagnosed)*

Parent of ADHDAdult with ADHDSpouse/Partner of ADHDWhole Fam Damily has ADHD

Ages and number of family members

Rows	1	2	3	4	5	6
< 5 years old
6 to 9 years old
10 - 14 yeas old
15 to 19 years old
20 - 25 years old
26+ years old

Where are you in your ADHD journey*

Family member/me just diagnosedJust starting to understand it, overwhelmed by amount of infoFeel like I've read every parenting book, nothing worksHave tried lots of things but still strugglingLooking to refine and grow what's already working
What are you hoping to gain by working with a coach?*

Improve family communicationCalmer life, less friction, less conflictBetter understanding of ADHDTools to help kids with ADHDImprove daily routinesSibling harmonyReduce parent stressUnderstand each other betterBetter family relationships
What have you tried to modify kid(s)' behavior?*

Restricting technologyBody doublingConstant remindersRewards - focus on the positivesTherapyFriends/siblings helpingTutorsLeft to own devices & life provides consequences - missed deadlines, missed appts, bad grades, etcBig consequences - lost privileges, long punishments, etcClear expectations & consistent routinesMedications
What has worked to modify kid(s)' behavior?*

Restricting technologyBody doublingConstant remindersRewards - focus on the positivesTherapyFriends/siblings helpingTutorsLeft to own devices & life provides consequences - missed deadlines, missed appts, bad grades, etcBig consequences - lost privileges, long punishments, etcClear expectations & consistent routinesMedicationsNone of the above
Where are you hoping kids make the biggest shifts? (choose up to 3)*

Improved relationships - family, making friendsOrganizationTime ManagementLess procrastinatingAble to start/finish tasksAble to ask for helpBetter impulse controlCan plan ahead betterEasier mornings - getting out of bed, enough time, eating breakfast, etc.
How do your kid(s) handle change?*

They are open to try new stuffChange is slowThey say they will try it then argue and don't tryThey do not like change at allIt has to be their idea
How do you feel about making changes?*

I'll try stuff and see what worksI've made a few changes in my lifeI like the way I do things, change is slowI don't need to change
How much time can you & family realistically commit to coaching and supporting this effort?*

Whatever it takes!3 - 4 hours per week1 - 2 hours per weekWe don't have much time
What's your budget for coaching? I offer intensives supported by an annual plan.*

$6,000+$4,000 - $6,000$1,000 - $3,999<$1,000
If we are a good fit, when are you looking to start?*

ASAP< 1 month from now2+ months from nowNot ready to start anytime soon
How often do you have big emotions in your house (some might say over-reactions)

1

2

3

4

5

6

1 is Rarely, 6 is Most days
How would you rate your stress level

1

2

3

4

5

6

1 is Totally manageable , 6 is Overwhelming
How would you rate your anxiety level

1

2

3

4

5

6

1 is Totally manageable , 6 is Overwhelming
Do you feel your kid(s) are impulsive?

1

2

3

4

5

6

1 is Not really, 6 is OMG Yes!
Is your life organized? time, house, office, mind, etc.

1

2

3

4

5

6

1 is Everything fits like it should, 6 is Not at all
Are you kind are you to yourself if you make a mistake?

1

2

3

4

5

6

1 is I love me!, 6 is Really mean
Why are you interested in finding support at this time? What's happened or changed recently?*

0/500
Is there anything that may hold you or members of your family back i.e inflexible thinking, don't like trying new tools, expressing thoughts freely, major anxiety, etc?*

0/500
What are your “have to dos”? You feel there is NO choice, you just have to do them. This gives me an idea of what is on your plate. Make a list of as many as you can think of. Just let the thoughts flow: do all the laundry, keep the house clean, organize everything, do things perfectly, take care of everyone, aging parents, visit aunt Milly, etc*

0/500
Please verify that you are human*
Should be Empty:

FOCUS Family Intensive Application