Salah & ADHD Interest Form

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for expressing interest in our programming. Your feedback will help us design programs to be launched soon inshaAllah!

Email *

First Name *

Last Name *

How did you hear about Salah & ADHD *

Muslim ADHD Conference or Interfaith ADHD Conference

Instagram: @SalahandADHD

I've attended previous workshops/support groups

Other:

What services would you be interested in joining in the next three months? *

support group around salah specifically

support group around ADHD more generally

one on one coaching services

ADHD book club hosted by a therapist

support group for muslim women with ADHD

support group for muslim men with ADHD

support group for parents of children/teens with ADHD

Other:

Required

Would you like to be put on a waiting list for one of these potential services? This is not a guarantee that these services will be made available, only that you will be prioritized should they be initiated. *

Yes

Any other feedback for program organizers on how your Salah and ADHD journey can be supported:

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms