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ADHD Strategy Session Background Questions

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Question 1 of 23

How old are you?

    Question 2 of 23

    Have you been diagnosed with ADHD?

    A

    I've been diagnosed by a medical professional

    B

    I'm self-diagnosed

    C

    I'm not sure if I have ADHD

    D

    I do not have ADHD

    Question 3 of 23

    If officially diagnosed, what was the approximate month and year you were diagnosed?

      Question 4 of 23

      Where do you currently live?

        Question 5 of 23

        Any children? If so, please list how many and their ages.

          Question 6 of 23

          Any pets?

            Question 7 of 23

            Occupation?

              Question 8 of 23

              Hours of work per week

              A

              Less than 10

              B

              10-20

              C

              20-40

              D

              More than 40

              Question 9 of 23

              Please list any health concerns:

                Question 10 of 23

                At what point in your life did you feel best?

                  Question 11 of 23

                  Any serious illnesses/hospitalizations/injuries?

                    Question 12 of 23

                    How's your sleep?

                    A

                    No complaints

                    B

                    Could be better

                    C

                    Terrible

                    Question 13 of 23

                    Allergies or sensitivities? Please explain

                      Question 14 of 23

                      Do you take any supplements or medications? Please list.

                        Question 15 of 23

                        Are you currently involved with any therapists, coaches, healers, or helpers? If so, please describe.

                          Question 16 of 23

                          What role does movement and/or exercise play in your life?

                            Question 17 of 23

                            What are you hoping to gain from this strategy session together?

                              Question 18 of 23

                              Will family and/or friends be supportive of your desire to make behavioral and/or lifestyle changes?

                                Question 19 of 23

                                Roughly what percentage of your food is home-cooked?

                                  Question 20 of 23

                                  Where do you get the rest from?

                                    Question 21 of 23

                                    Do you crave sugar, caffeine, nicotine, or have any major addictions?

                                      Question 22 of 23

                                      The most important thing I'd like to change in my life is ...

                                        Question 23 of 23

                                        Please add anything else you'd like me to know before our strategy session.

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