Are you ready for Coaching?
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
What time zone are you in?
*
Pacific
Mountain
Central
Eastern
Other
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Select the number that comes closest to how true each statement is for you right now. (1 = No, 5 = Yes)
*
Rows
Score 1=No and 5=yes
I will do the things I say I will do. If something is difficult for me, I will discuss this with my coach so that we can work around it.
1
2
3
4
5
I could use someone to help me focus, challenge me, and hold me accountable to my commitments.
1
2
3
4
5
I understand that achieving goals takes time; Rome was not built in one day. I am willing to invest all of the time required to achieve my goals.
1
2
3
4
5
I am fully willing to do the work required and understand that the success of coaching is up to me.
1
2
3
4
5
I will honestly commit to the time needed for appointments and can be relied upon to be on time and ready for all of my appointments.
1
2
3
4
5
Calculation
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A few questions about you
These help us prepare for our first conversation, so we spend our time on what matters to you. There are no wrong answers. If you're filling this out for someone else, answer as best you can for them.
Who is the coaching for?
*
Me (I'm 18 or older)
My child or teen
My child and me together
Other
Which would you prefer?
*
A small group with other adults with ADHD
One-on-one
Not sure yet
How soon do you want to start?
*
This week
Within 2 weeks
Within a month
Just exploring
Coaching is a monthly investment. Which fits where you are right now?
*
I'm ready to invest now
I'd need to plan for it
I'm not in a position to right now
Is anyone else part of this decision?
*
No, it's my decision
My spouse or partner
My parent
My employer
What happened recently that made you reach out now?
*
Submit
Should be Empty: