The Joys of Unmasking Pre-Assessment Questionnaire

1

Name* This field is required.

First Name

Last Name

2

Email Address* This field is required.

3

Phone Number* This field is required.

Please enter a valid phone number.

4

How old are you?* This field is required.

5

Have you been diagnosed with ADHD by a medical/mental health professional, or have you self diagnosed? How long have you been diagnosed with ADHD?* This field is required.

6

What attracted you to this group?* This field is required.

7

Are there symptoms or behaviors related to the ADHD diagnosis that are negatively impacting your life? If yes, then please briefly explain in what ways?* This field is required.

8

Thank you for completing this form and for your interest in this support group. What is the best way for me to reach you in order to discuss next steps?