Interested in joining this group and/or learning more? Please complete the below information and we will reach out to you shortly. Parent/Guardian's Full Name Phone E-mail State of Residence Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Preferred Method of Contact Phone E-mail No Preference Child's Full Name Age School Grade Current school accommodations (if any) Has your child been formally diagnosed with ADHD? Yes No Awaiting evaluation results If yes, what ADHD diagnosis? Predominantly Inattentive Presentation Predominantly Hyperactive-Impulsive Presentation Combined Presentation Unsure If yes, who diagnosed your child? Date of Diagnosis (month/year or "N/A") Provider type: Psychologist/Evaluator Pediatrician Psychiatrist Other Not Applicable Please list any additional mental health concerns, suspected and/or diagnosed (e.g., anxiety; depression; learning differences; etc.): Have you previously sought Parent Consultation for ADHD? Yes No Is your child currently taking psychiatric medication intended to manage his/her ADHD symptoms? Yes No Is your child currently in individual therapy? Yes No If so, are you comfortable sharing with your child's therapist the fact that you may participate in this therapy group? Yes No Not applicable What would you hope to get out of this group? What questions do you have about this group (if any)? Do you have a preference for how we meet? In-person Virtually I'm flexible Is there any additional information you'd like to share with us? I learned of this group from: Professional School Family/Friend Internet Other Submit Share this:Click to email a link to a friend (Opens in new window)