Name *

First Name

Last Name

Phone

(###)

###

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What topics are most important to you? Check all that apply. *

Understanding ADHD - what it is, what it isn't

Overstimulation + Emotion Regulation

Finding things, remembering things

Starting, working through, and completing tasks

Social skills and active listening

Self-care, relaxation, personal hygiene

Other (specify in the text box at the end of this form)

Are you diagnosed with ADHD?* *

*A lack of diagnosis does not preclude you from the group.

Yes

No