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ADHD Strategy Session Application

Please answer the following questions to see if you qualify for a FREE 45-Minute ADHD Strategy Session with Dr. D. LeGrand Peterson, ND!

**If you are applying for yourself answer the questions for just yourself and if you are applying for your child answer the questions for your child.**

***It will take you less than 5 minutes to answer the questions***

Click the button below to start.

Start

Question 1 of 23

Do you or your child have ADHD?

A

Yes

B

No

Question 2 of 23

Do you or your child have anxiety?

A

Yes

B

No

Question 3 of 23

Do you or your child have depression?

A

Yes

B

No

Question 4 of 23

Do you or your child feel overwhelmed?

A

Yes

B

No

Question 5 of 23

Do you or your child feel distracted and inattentive?

A

Yes

B

No

Question 6 of 23

Do you or your child have trouble with or want to improve...Motivation?

A

Yes

B

No

Question 7 of 23

Do you or your child have trouble with or want to improve...Productivity?

A

Yes

B

No

Question 8 of 23

Do you or your child have trouble with or want to improve...Focus?

A

Yes

B

No

Question 9 of 23

Do you or your child have trouble with or want to improve...time management skills?

A

Yes

B

No

Question 10 of 23

Are you or your child excessively active or feel restless?

A

Yes

B

No

Question 11 of 23

Are you or your child taking any medications for ADHD or Anxiety or Depression?

A

Yes

B

No

Question 12 of 23

Do you or your child have trouble with sleep?

A

Yes

B

No

Question 13 of 23

Do you or your child have other health concerns?

A

Yes

B

No

Question 14 of 23

Do you or your child have trouble with or want to improve...Performance?

A

Yes

B

No

Question 15 of 23

Do you or your child have trouble with or want to improve...Confidence?

A

Yes

B

No

Question 16 of 23

Do you or your child feel fulfilled in life?

A

Yes

B

No

Question 17 of 23

What is your biggest concern today for either yourself or for your child?

A

ADHD

B

Anxiety

C

Stress

D

Overwhelm

E

Productivity

F

Motivation

G

Performance

H

Confidence

I

Focus

J

Fatigue/Burnout

K

A Sense of Fulfillment

L

Relationships

M

Behavior

N

Overall Health

O

Something Else

Question 18 of 23

How soon do you want to begin your wellness journey for yourself or for your child?

A

Now

B

1-2 months

C

3-6 months

D

> 6 months

Question 19 of 23

How long do you think it will take to achieve the level of health and happiness you desire for yourself or for your child?

A

< 1 month

B

1-2 months

C

3-6 months

D

6-12 months

E

1-2 years

F

> 2 years

G

Never

Question 20 of 23

What is your present level of commitment to address any underlying causes of your own signs and symptoms that relate to your lifestyle or for your child? Rate from 1-10 (10 being 100% committed)*

A

10

B

9

C

8

D

7 or less

Question 21 of 23

Are you willing and able to do virtual telemedicine video consults?

A

Yes

B

No

Question 22 of 23

How much are you willing and able to invest in yourself or for your child PER MONTH to be able to thrive in your own health or your child's health, wellbeing, and life? (That will NOT be covered by insurance at all).*

A

less than $100/Month

B

$100-250/month

C

$300-400/month

D

$400-700/month

E

$700-1000/month

F

$1000-2000/month

G

I'm willing to invest as much as it takes to feel better

Question 23 of 23

Are you willing to commit to a 6-month program in order to see the results you want for either yourself or for your child?

A

Yes

B

No

C

Tell me more first

Confirm and Submit