Adult ADHD Group Coaching — Interest Survey
Thanks for your interest! This quick survey helps me understand what you're looking for and figure out if this group is the right fit. Takes about 3-4 minutes. No wrong answers.
Let's start with the basics
Quick stuff first — name, contact, and when you're free.
Full Name
*
First Name
Last Name
Email address
*
example@example.com
Phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Best way to reach you about joining the group (be sure to leave your phone number if text/call is preferred)
*
Email
Text
Phone call
Other
What days of the week are you most available? (select all that could work)
*
Monday
Tuesday
Wednesday
Thursday
Friday
What time of day works best? (select all that could work)
*
Morning (8am-11am)
Midday (11am-1pm)
Early afternoon (1pm-4pm)
Evening (5pm-7pm)
Back
Next
Let me know what's going on
This is the part that helps me figure out if this group is right for you.
What's the thing you're hoping group coaching will help you tackle? (Be as specific or as messy as you want.)
*
What best describes you? (select all)
*
Diagnosed with ADHD
Self-identified / suspect I have ADHD
Parent
Working professional
Entrepreneur / business owner
Student (grad school, returning to school, certification, etc.)
Caregiver (aging parent, family member, etc.)
In a major life transition (move, career change, divorce, new diagnosis, etc.)
Other
Have you done coaching, therapy, or group work before? What worked or didn't?
Describe your ideal group coaching setup. (Who you'd want in the room, group size 5-8 or under 15, structured vs. conversational, what would make you comfortable enough to show up.)
What would make this a 'yes' for you to join? (Or flip it — what's making you hesitant? Cost, time, 'I've tried stuff before and it didn't work,' fear of group settings — whatever it is, tell me.)
Back
Next
Last thing
Almost done — just a couple quick ones.
Where did you learn about this group? (Be specific — which FB group, who referred you.)
*
Anything else you want me to know? (Optional.)
Submit
Should be Empty: