Who is interested in being coached?
| Name of person being coached (if YOU are the person, skip this field) | {"type":"text","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
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| Email address (if applicable - if YOU are the person interested, skip this field) | {"type":"text","name":"__generic2","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
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| Age | {"type":"text","name":"__generic4","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
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| Your relationship to them | {"type":"text","name":"__generic4","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
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Have you/they previously worked with a coach?
SelectYesNo{"type":"select","name":"__generic5","width":20,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Select\nYes\nNo"}
Which executive function areas are most in need of support?
(Choose your top 3){"type":"checkbox","name":"__generic6","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please check at least one item.","options":"Emotion Regulation\nImpulsivity\nFlexible Thinking\nTime Management\nPlanning/Remembering\nOrganization\nProblem Solving\nTask Initiation\nFollow Though"}
What reasons made these your top 3?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":50,"placeholder":""}
If coaching were successful, what would be different in 3–6 months?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":50,"placeholder":""}
| What’s your current urgency level for coaching? | Select🟩 We’re planning ahead🟨 We’d like to be proactive🟨 It’s becoming a concern🟧 It’s impacting daily life🟧 We’re overwhelmed🟥 We’re in crisis mode{"type":"select","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Select\n🟩 We’re planning ahead\n🟨 We’d like to be proactive\n🟨 It’s becoming a concern\n🟧 It’s impacting daily life\n🟧 We’re overwhelmed\n🟥 We’re in crisis mode"}
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What else feels important to share before we meet?
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
How did you discover Emergent Focus?SelectADDA Professional DirectoryADHD Coaches OrganizationCHADD Professional DirectoryClient ReferralProfessional ReferralWeb SearchOther{"type":"select","name":"discoverySource","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please make a selection for this item.","options":"Select\nADDA Professional Directory\nADHD Coaches Organization\nCHADD Professional Directory\nClient Referral\nProfessional Referral\nWeb Search\nOther"}