{"id":1084,"date":"2020-11-10T15:42:44","date_gmt":"2020-11-10T15:42:44","guid":{"rendered":"https:\/\/lyndahoffman.com\/en-us\/?page_id=1084"},"modified":"2026-04-30T05:20:43","modified_gmt":"2026-04-30T09:20:43","slug":"questionnaire-for-adults-with-adhd","status":"publish","type":"page","link":"https:\/\/lyndahoffman.com\/en-us\/contact\/questionnaire-for-adults-with-adhd\/","title":{"rendered":"Questionnaire for Adults with ADHD"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1084\" class=\"elementor elementor-1084\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-680100dd elementor-section-full_width elementor-section-stretched elementor-section-height-default elementor-section-height-default\" data-id=\"680100dd\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;stretch_section&quot;:&quot;section-stretched&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-26cdf7e8\" data-id=\"26cdf7e8\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-6fbd366f elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"6fbd366f\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-738a263e\" data-id=\"738a263e\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5d2147dc elementor-widget elementor-widget-heading\" data-id=\"5d2147dc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Questionnaire for Adults with ADHD<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7f34a01c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7f34a01c\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-3b8f1e15\" data-id=\"3b8f1e15\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f28a2b7 elementor-widget elementor-widget-text-editor\" data-id=\"f28a2b7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h5 class=\"title-gray\">Please complete this questionnaire so that you get the very most from our time together.<\/h5><p>\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1187-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1187\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en-us\/wp-json\/wp\/v2\/pages\/1084#wpcf7-f1187-o1\" method=\"post\" class=\"wpcf7-form init 432856892a5e cmatic-conn cmatic-aud-2 cmatic-mapd0-0 cmatic-098115 cmatic-sent-0 cmatic-total-7\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1187\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.7\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1187-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"custom-forms\">\n\t<p class=\"item-size3\"><label>Name*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span><\/label>\n\t<\/p>\n\t<p class=\"item-size3\"><label>Email*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span><\/label>\n\t<\/p>\n\t<p class=\"item-size3\"><label>Phone*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-phone\" \/><\/span><\/label>\n\t<\/p>\n\t<p class=\"item-size2\"><label>City*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-city\" \/><\/span><\/label>\n\t<\/p>\n\t<p class=\"item-size2\"><label>Province or state*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-state\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-state\" \/><\/span><\/label>\n\t<\/p>\n\t<p><label>1. In what way(s) do you believe ADHD is posing a challenge in your life? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-area-1\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"text-area-1\"><\/textarea><\/span><\/label>\n\t<\/p>\n\t<p><label>2. If we coach together, what will we be celebrating on our last day? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-area-2\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"text-area-2\"><\/textarea><\/span><\/label>\n\t<\/p>\n\t<p><label>3.How important is this change to your life on a scale from 1 to 10? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"selected-1\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"selected-1\"><option value=\"Please select (1 least and 10 best)\">Please select (1 least and 10 best)<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><\/select><\/span><\/label>\n\t<\/p>\n\t<p><label>4. How prepared are you to come to our sessions with an agenda or an idea about the topic to explore?*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"selected-2\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"selected-2\"><option value=\"Please select (1 least and 10 best)\">Please select (1 least and 10 best)<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><\/select><\/span><\/label>\n\t<\/p>\n\t<p><label>5. How ready are you to do the work between sessions and let your coach do the coaching?*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"selected-3\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"selected-3\"><option value=\"Please select\">Please select<\/option><option value=\"I&#039;m completely willing to do what it takes to follow through so I can succeed in my learning.\">I&#039;m completely willing to do what it takes to follow through so I can succeed in my learning.<\/option><option value=\"I am committed and ready but worry I might not follow through.\">I am committed and ready but worry I might not follow through.<\/option><option value=\"I am not yet ready to commit to doing anything between sessions.\">I am not yet ready to commit to doing anything between sessions.<\/option><\/select><\/span><\/label>\n\t<\/p>\n\t<p><label>6. How ready and willing are you to do the deep inner work to become fully in charge of your outcomes? *<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"selected-4\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"selected-4\"><option value=\"Please select\">Please select<\/option><option value=\"Yes, let\u2019s do this!\">Yes, let\u2019s do this!<\/option><option value=\"Ready but not sure what this looks like\">Ready but not sure what this looks like<\/option><option value=\"I don\u2019t see the point.\">I don\u2019t see the point.<\/option><\/select><\/span><\/label>\n\t<\/p>\n\t<p><label>7. What is your default pattern when there is a difficult conversation to be had?*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"selected-5\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"selected-5\"><option value=\"Please select\">Please select<\/option><option value=\"I run the other way\">I run the other way<\/option><option value=\"I know I want to say something but I\u2019m afraid of the other person\u2019s reaction\">I know I want to say something but I\u2019m afraid of the other person\u2019s reaction<\/option><option value=\"I will say something to the person even if I am uncomfortable doing so\">I will say something to the person even if I am uncomfortable doing so<\/option><option value=\"No problem! I am super comfortable\">No problem! I am super comfortable<\/option><\/select><\/span><\/label>\n\t<\/p>\n\t<p><label>8. How would you rate your zest for life and your excitement about creating something better for yourself?*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"selected-6\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"selected-6\"><option value=\"Please select (1 least and 10 best)\">Please select (1 least and 10 best)<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><\/select><\/span><\/label>\n\t<\/p>\n\t<p><label>9. Do you have dependency on substances that alter your ability to think clearly?*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"selected-7\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"selected-7\"><option value=\"Please select\">Please select<\/option><option value=\"No\">No<\/option><option value=\"Yes, I&#039;m fine with it\">Yes, I&#039;m fine with it<\/option><option value=\"Yes, I&#039;m in recovery with support\">Yes, I&#039;m in recovery with support<\/option><option value=\"Yes, I&#039;m open to getting support\">Yes, I&#039;m open to getting support<\/option><\/select><\/span><\/label>\n\t<\/p>\n\t<p><label>10. Please indicate how true this statement is: I am financially able and prepared to create the funds to pay for coaching. (1 \u2013 not at all and 10 \u2013 completely)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"selected-8\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"selected-8\"><option value=\"Please select (1 least and 10 best)\">Please select (1 least and 10 best)<\/option><option value=\"1\">1<\/option><option value=\"2\">2<\/option><option value=\"3\">3<\/option><option value=\"4\">4<\/option><option value=\"5\">5<\/option><option value=\"6\">6<\/option><option value=\"7\">7<\/option><option value=\"8\">8<\/option><option value=\"9\">9<\/option><option value=\"10\">10<\/option><\/select><\/span><\/label>\n\t<\/p>\n\t<p><label>11. Why choose to work with me?*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-area-3\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"text-area-3\"><\/textarea><\/span><\/label>\n\t<\/p>\n\t<p>[recaptcha]\n\t<\/p>\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"SUBMIT\" \/>\n\t<\/p>\n<\/div><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"6\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/p><p>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.<\/p><p>You can find the ICF Code of Ethics here: <a href=\"https:\/\/coachfederation.org\/code-of-ethics\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/coachfederation.org\/code-of-ethics<\/a><\/p><p>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.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Questionnaire for Adults with ADHD Please complete this questionnaire so that you get the very most from our time together. 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 [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":1070,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"_acf_changed":false,"footnotes":""},"wf_page_folders":[55],"class_list":["post-1084","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Questionnaire for Adults with ADHD | Lynda Hoffman<\/title>\n<meta name=\"description\" content=\"Do you already know the questionnaire for adults with ADHD? If you want to make the most of our time together, fill out this form on our website. 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