Book your CONSULT easily with Judy or Joy.

Duration: 40 minutes
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Welcome to the first step in your journey for support!  I am excited to meet/speak with you and would love if you could provide a little bit of information to help us along the way.


NAME:  {"type":"text","name":"NAME","width":70,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}


1.  How did you find me?  (yea, that marketing info I like to have)

{"type":"checkbox","name":"marketing","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","options":"Internet search\nSearch specifically for Coach\nGoogle Business Page\nDirectory (CHADD, ACO, ADDitude) please specify which below\nPsychologist or other professional (please specify which below)\nFriend (optional to provide name)"}



{"type":"text","name":"Details","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}



2.  What are the challenges you (or your child) is facing daily? 
{"type":"checkbox","name":"challenges","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","options":"frustration\ndifference\ndepressed\nno motivation\nfeel stupid\ndis-organized\nno time management\noverwhelm\nanxiety\nrelationship issues\nself-confidence\nstarting tasks\ncompleting tasks\nOTHER"}



3.  What is the #1 goal/thing most important to you today?
{"type":"textarea","name":"mostimportant","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}



4.  Is this regarding yourself?  If YES, please skip the next question{"type":"radio","name":"regarding","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","options":"YES\nNO"}


5.  If this is regarding a teen, please check all that apply
{"type":"checkbox","name":"teeninfo","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","options":"10-12 years of age\n13-15 years of age\n16-21 years of age\nOver 21\ncollege student\nhigh school student\nmiddle school student"}



6.  Best way to reach you?  {"type":"text","name":"phone","width":30,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}


7.  What do you want it all to look like with changes implemented?  What is your goal/dream/outlook?  
{"type":"textarea","name":"goal","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}



9.  Would you prefer to be added to my email newsletter tribe?  

10.  Anything else you wish for us to know?{"type":"text","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}















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