Let’s work together Name * First Name Last Name Email * Mobile Country (###) ### #### Emergency Contact First Name Last Name Relationship to you Please share a bit about your ADHD journey so far. For example: when you found out about your ADHD? How it's affecting your life? Any modifications you've made so far to support your ADHD? etc What are the current challenges you are experiencing with ADHD? What are your biggest desires when it comes to ADHD support & management? What has lead you to reach out for ADHD coaching now? What are you hoping to have the support / accountability with moving forward? What are your main goals with ADHD coaching? Are you a big procrastinator? If so, where do you notice you procrastinate the most? Tell me a little bit about your relationship to self care. For example, exercise, meditation, journalling or any general practices you enjoy engaging in for your overall wellbeing. Do you have any pre existing medical or mental health conditions? If yes, please provide detail. On a scale of 0 (poor) - 10 (excellent) how would you rate your levels of overwhelm? SELF AWARENESS eg being unaware of feelings, needs or experiences. Experiences burn out and overwhelm Never Rarely Sometimes Often Always Other (please give detail below) PROBLEM SOLVING eg difficulty breaking tasks down, decision paralysis or self sabotaging behaviours like people pleasing, perfectionism etc Never Rarely Sometimes Often Always Other (please give detail below) INHIBITION (IMPULSIVITY) eg 'acting before thinking', challenges finishing tasks, jumps from task to task, lashes out at people Never Rarely Sometimes Often Always Other (please give detail below) MOTIVATION eg hacking your interest based nervous system, hyperfocus vs procrastination Never Rarely Sometimes Often Always Other (please give detail below) EMOTIONAL REGULATION eg experiencing intense emotions, Rejection Sensitive Dysphoria Never Rarely Sometimes Often Always Other (please give detail below) MEMORY eg forgetting appointments, information & instructions Never Rarely Sometimes Often Always Other (please give detail below) INNER MONOLOGUE eg ruminating, overthinking & distracting thoughts Never Rarely Sometimes Often Always Other (please give detail below) PLANNING eg time management & organisation Never Rarely Sometimes Often Always Other (please give detail below) SELF COMPASSION eg being kind to yourself through your thoughts and beliefs. Ability to support and be kind to yourself when you're down or struggling with your ADHD Never Rarely Sometimes Often Always Other (please give detail below) Please share anything else you would like me to know or if you have any questions at all. Thank you! I’ll be in contact shortly :)