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Consult Request
Please fill out this form to join our waitlist. (Thank you in advance for your patience!)
*Quick Tip:
To apply for one of our groups, fill out our separate Group Consult Request form on our webpage.
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Email
*
Your email
Full Name
Your answer
Phone Number
Your answer
City & State
Your answer
Birthday
MM
/
DD
/
YYYY
Age
*
Your answer
Who are you seeking help for?
*
Myself
\ Someone Else
Me and a loved one
What is the main issue/s you are wanting help with? (Details are helpful but not required, don't worry about spelling/grammar!)
*
Your answer
How did you hear about us?
*
Additude
ACO
CHADD
ADDA
Doctor
Friend/Family/Loved one
Google
Current/Former MindFuel client
Other:
Required
Do we have permission to text you regarding phone consult details?
*
Yes
No
Are you interested in enrolling in group coaching? (Mark all that apply).
*
Foundations for Adult ADHD Mastery
Mastering ToDo's & Planning
MOMENTUM ( ADHD Adult Accountability Group- Monthly Membership)
Mastermind Group (for Aspiring Entrepreneurs/Self-Employed/Indie Professionals)
Power Sessions (Virtual Co-Working )
No
Maybe.
Other:
Required
What is your general availability to attend individual/groups? (We understand schedules change)
*
Mornings (9am-12pm)
Lunchtime (12pm-1:30pm)
Mid-Afternoon (1:30pm-3:00pm)
Late Afternoon (3:30pm-5:00pm)
Evening (5pm-7pm)
Pretty Flexible most days
I can't say, it always varies.
Other:
Required
Which days of the week?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Pretty flexible most days
I can't say, it always varies.
Other:
Required
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