Questionnaire for Adults with ADHD

Questionnaire for Adults with ADHD

Please complete this questionnaire so that you get the very most from our time together.

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 important is this change to your life on a scale from 1 to 10? *

4. What belief do you need to let go of in order to make this change?*

5. On a scale from 1-10: How committed are you to the coaching process -- even during times when it feels hard? (1 - not very committed and 10 - totally committed)*

6. How willing are you to do the deep inner work to become fully in charge of your outcomes? *

7. What is your default pattern when there is a difficult conversation to be had?*

8. On a scale from 1-10, 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)*

9. Why choose to work with me?*

Everything you share with me will be kept completely confidential. I am a professional certified coach (PCC), and a member in good standing of the International Coach Federation (ICF), and I adhere to the ICF Code of Ethics.

You can find the ICF Code of Ethics here: https://coachfederation.org/code-of-ethics

I look forward to learning more about you, what you want to bring to the world and how I can help you develop the personal leadership skills to make that a reality.