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Welcome

to GPS Membership!

Thank you for taking the time to complete this brief intake form. Your responses here will help me to get to know you better prior to our first session. I look forward to working with you!

- Nikki

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

Where did you hear about the GPS Membership?

What made you decide to join the membership?

What would you like to get out of the membership?

What kind of calendar do you use?

How do you organize your tasks?

What are your top 3 challenges when it comes to managing time and tasks?

What questions, comments, or concerns do you have?

Not just another weekly newsletter!

We know you don’t need something else to overwhelm you. That’s why our weekly newsletter offers a focused approach to a problem and a recent episode of our podcast, Taking Control: The ADHD Podcast, for you to reflect on and — hopefully — integrate into your life. And that’s it. Simple, clear, and practical.

© Take Control ADHD

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