Consultation Pre-screening form
let's make sure a consultation with Dusty is the right fit for you! No matter what, I'm committed to helping you connect to the resources and support you need.
Sign in to Google to save your progress. Learn more
What is today's date? *
MM
/
DD
/
YYYY
Name? *
How did you find out about coaching with us? (Google search, referral, social media) - please let us know the name of who referred you or which social media platform led you to us! *
Pronouns? *
Email address? *
Phone Number? *
What is your time zone? *
What is your occupation, if any? *
Are you currently pregnant or planning to become pregnant, and are interested in pregnancy group coaching? *
In a brief summary, please describe what struggles you are facing with your ADHD: *
How soon/urgently are you in need of coaching support? *
Have you ever worked with a coach before, whether for ADHD or otherwise? *
What are you hopeful that coaching can help you with? *
I strive to make my coaching inclusive and accessible for everyone, regardless of their ability to pay. I have a few different options to make coach accessible to you. What are you hoping coaching will cost/ what would you be comfortable paying for coaching? (this info also helps me if I need to refer you to another coach or specialist) *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Vancouver ADHD Coaching. Report Abuse
Google Forms