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Adult ADHD Strategy Session Application

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

***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 have ADHD?

A

Yes

B

No

Question 2 of 23

Do you have anxiety?

A

Yes

B

No

Question 3 of 23

Do you have depression?

A

Yes

B

No

Question 4 of 23

Do you feel overwhelmed?

A

Yes

B

No

Question 5 of 23

Do you feel distracted and inattentive?

A

Yes

B

No

Question 6 of 23

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

A

Yes

B

No

Question 7 of 23

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

A

Yes

B

No

Question 8 of 23

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

A

Yes

B

No

Question 9 of 23

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

A

Yes

B

No

Question 10 of 23

Are you excessively active or feel restless?

A

Yes

B

No

Question 11 of 23

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

A

Yes

B

No

Question 12 of 23

Do you have trouble with sleep?

A

Yes

B

No

Question 13 of 23

Do you have other health concerns?

A

Yes

B

No

Question 14 of 23

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

A

Yes

B

No

Question 15 of 23

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

A

Yes

B

No

Question 16 of 23

Do you feel fulfilled in life?

A

Yes

B

No

Question 17 of 23

What is your biggest concern today?

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?

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?

A

< 1month

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 signs and symptoms that relate to your lifestyle? 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 PER MONTH to be able to thrive in your 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?

A

Yes

B

No

C

Tell me more first

Confirm and Submit