Neurodivergent Business & Professional Listing Application
Christa Holmans, Neurodivergent Rebel, is building a strong network of Neurodivergent business professionals. I'm looking to build a network of speakers, artists, doctors, mental health professionals, hair stylists - professionals of all types in all parts of the world.

There is no cost to be included in the network/listing. Anyone can subscribe to the emails, however only vetted and approved businesses, with references, will be added to the public listing.

If you would like to be considered for inclusion, please provide the following information along with any other information that you would like considered.
Name *
Business Name
Description of services you provide *
Email *
Phone number
Country & State *
Additional information for consideration
What sets your business apart? What makes your company different? *
What is your understanding of neurodiversity? *
Professional References - Please copy and paste recommendation information below.
If application is approved, would you like to be included in my web-listing of Neurodivergent Business Professionals? *
Would you like to receive emails and additional information, including potential business opportunities, from Neurodivergent Consulting? *
Would you like for me to share YOUR information with the network of Neurodivergent Business Professionals? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy