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Student Age
Has your child received a formal ADHD diagnosis?
Yes
No
In evaluation process
Prefer not to say
🔎 SECTION 2: Executive Function Snapshot
Inactive
Hyperactive
Combined
Unsure

Which ADHD presentation best fits your child?

On most days, my child struggles most with:
How long can your child focus independently (approximate)?
Less than 2 minutes
3-4 minutes
5–7 minutes
8= minutes
🎯 SECTION 3: Academic & Thinking Profile

Strength Areas (choose all that apply):

Does your child resist structured work?
Often
Sometimes
Rarely
Does your child respond well to movement breaks?
Yes
Sometimes
Not sure
Where do you see the most friction right now?
Homework
Morning routines
Bedtime
Emotional reactions
School communication
Sibling interactions
Are you currently using any of the following supports?
Medication
Therapy
School IEP/504
None
Prefer not to say
🧩 SECTION 5: Learning Preferences

My child learns best through:

What motivates your child most?
Competition
Rewards
Praise
Mastery
Choice
Social interaction

(1 = Rarely, 4 = Consistently)

(1 = Rarely, 4 = Consistently)

(1 = Rarely, 4 = Consistently)

(1 = Rarely, 4 = Consistently)

(1 = Rarely, 4 = Consistently)

Is there anything important I should know when designing your child’s welcome packet?

📌 SECTION 8: Commitment
I agree

I understand this program trains executive thinking skills and is not therapy or medical treatment.

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