New client form

This is just so I don't need to repeat questions when we meet. All information is kept strictly confidential.

First name

Last name

Email

What age bracket are you in

Under 10yo *sorry I don't work with this age

10-15yo

16-20yo

21-30yo

31-40yo

41-50yo

51+yo

In person - Luxembourg - or remote coaching?

Luxembourg

Remote - whatsapp or tbd

Hybrid

Are you diagnosed with ADHD?

Yes

No

If yes, what with? Eg AuDHD

If yes, when and by whom? Eg 2024 in the UK

Are you on medication for neurodivergency eg ADHD?

What do you hope to get out of ADHD coaching?

Briefly describe your current circumstances?

Any other comments?

Email

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