Are you ready?

Name*

Email*

Phone*

City*

Province or state*

1. In what way(s) do you believe ADHD is posing a challenge in your life? *

2. If we coach together, what will we be celebrating on our last day? *

3. How ready are you to do the work between sessions and let your coach do the coaching?*
Please selectI'm completely willing to do what it takes to follow through so I can succeed in my learning.I am committed and ready but worry I might not follow through.I am not yet ready to commit to doing anything between sessions.

4. How ready and willing are you to do the deep inner work to become fully in charge of your outcomes? *
Please selectYes, let’s do this!Ready but not sure what this looks likeI don’t see the point.

5. What is your default pattern when there is a difficult conversation to be had?*
Please selectI run the other wayI know I want to say something but I’m afraid of the other person’s reactionI will say something to the person even if I am uncomfortable doing soNo problem! I am super comfortable

6. How would you rate your zest for life and your excitement about creating something better for yourself?*
Please select (1 least and 10 best)12345678910

7. Please indicate how true this statement is: I am financially able and prepared to create the funds to pay for coaching. (1 – not at all and 10 – completely)*
Please select (1 least and 10 best)12345678910