1) How did you hear about us?:
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{"type":"text","name":"coachingStrength_comment","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":"Comments"}
2) If you are you enquiring on behalf of somebody else (e.g. child, spouse, colleague), please state their name and relationship to you:
{"type":"text","name":"clientMotivation_comment","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":"Type N/A if you are scheduling for yourself"}
3) Have you, or your family member, been diagnosed with ADHD and are taking medication?:
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{"type":"text","name":"clientMotivation_comment2","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":"Comments"}
4) What is your occupation?:
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":30,"placeholder":"Type N/A if not in work"}
5) What obstacles, challenges and struggles do you regularly come up against?:
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6) What would you like to see happening within the next 12 months (realistic goals, but should be a bit of a stretch)?:
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7) Which of our services are you interested in accessing?:I look forward to speaking with you soon.