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Let's chat!

Please fill out and submit the form below and you'll be sent an email invite to book a complimentary 20 minute call to see if we are a good fit to work together. Click here if you prefer to download the print version of the form.

Have you been formally diagnosed with Adhd?
Do you see a psychiatrist, therapist or other treatment provider?
FOR WOMEN:
PMS?
Perimenopause?
Menopause?
COACHING CALLS

Thank you for your email. I will respond within 48 hours.

Download Versions

Below are versions of the above form which you can download. Choose from a version that you print out, fill in, then scan/photograph and email back to us or a PDF version that you can fill-in using Adobe Acrobat Reader, then save, and email back to us.

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