Consultation Pre-screening form

let's make sure a consultation with Dusty is the right fit for you! No matter what, I'm committed to helping you connect to the resources and support you need.

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What is today's date?*

Name?*

First Last

How did you find out about coaching with us?*

(Google search, referral, social media) - please let us know the name of who referred you or which social media platform led you to us!

Email Address*

Phone Number*

What is your time zone?*

What is your occupation, if any?*

Are you currently pregnant or planning to become pregnant, and are interested in pregnancy group coaching?

Yes

In a brief summary, please describe what struggles you are facing with your ADHD:*

How soon/urgently are you in need of coaching support?*

Have you ever worked with a coach before, whether for ADHD or otherwise?*

What are you hopeful that coaching can help you with?*

I strive to make my coaching inclusive and accessible for everyone, regardless of their ability to pay. I have a few different options to make coach accessible to you. What are you hoping coaching will cost/ what would you be comfortable paying for coaching? (this info also helps me if I need to refer you to another coach or specialist)*

less than $100 a month

$100-300 a month

More than $300 a month

more than $500 a month

Name

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Consultation Pre-screening form

We offer a free phone or video consultation to all potential clients.

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