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Question 1 of 23
How old are you?
Question 2 of 23
Have you been diagnosed with ADHD?
I've been diagnosed by a medical professional
I'm self-diagnosed
I'm not sure if I have ADHD
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
Less than 10
10-20
20-40
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?
No complaints
Could be better
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.