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. "*" indicates required fields What is today's date?* MM slash DD slash YYYY 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 No 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 PhoneThis field is for validation purposes and should be left unchanged.