Name *

First Name

Last Name

Phone

(###)

###

####

Which group are you interested in? *

"Regular" group is adults of all ages and genders. It is held on Sundays from 10-11:30 EST. "Moms" group is for adult mothers of all ages and stages. It is held on Wednesdays from 6:30-8 PM EST.

"Regular" ADHD group

"Moms" ADHD group

Either is fine

What topics are most important to you? Check all that apply. *

Understanding ADHD - what it is, what it isn't

Overstimulation + Emotion Regulation

Finding things, remembering things

Starting, working through, and completing tasks

Social skills and active listening

Self-care, relaxation, personal hygiene

Other (specify in the text box at the end of this form)

Are you diagnosed with ADHD?* *

*A lack of diagnosis does not preclude you from the group.

Yes

No