Parent 1 Name
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Parent 2 Name (optional)
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Child 1 Name and age {"type":"text","name":"__generic5","width":100,"value":"","size":"Small","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
Child 2 Name and age (optional)
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Child 3 Name and age (optional)
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How would you currently rate your personal knowledge of ADHD?
Scale of 1 (very little)-10 (excellent)
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If you had to define ADHD to someone (eg a teacher ) what would you say?
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How would you currently rate your personal knowledge of the executive functions and their impact on ADHD?
Scale of 1 (very little)-10 (excellent) {"type":"radio","name":"__generic10","width":10,"value":"","size":"Small","validation":"","validationMessage":"Please make a selection for this item.","options":"1\n2\n3\n4\n5\n6\n7\n8\n9\n10"}
What is it about your child that helps them stand out in a positive way? (their strengths) - eg Kindness, creativity, team player, high energy
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What are the challenges that your child is facing? (eg - not having a study plan or knowing when assessments are due, too much social media? Forgetfulness? Feeling overwhelmed or anxious?
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What would you like to see your child/student to work on during this program (eg better planning, better sleep habits, strategies for focus)?{"type":"textarea","name":"__generic13","width":100,"value":"","size":"Small","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
It would be ideal if you can check-in weekly with your child/student about what they are working on in this program, are you able to do this?
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