Welcome
Free Consult
The Basics
Help
Are You?
Resources
Q&A
About
Services
Diagnostic Services
Testimonials
GrADDitude Donation
Customized Course on ADD
Cute Quotes from ADDers
One Time Consultations
Regina M. Cashman M.A., A.B.M.P.D., regina @addcoach.info (203)595-9161

__________________________________________________________________

One Time Consultations are only available after you have had the Initial Consultation. Use this form each time you would like to request a One Time Consultation. This feature is available for those who feel they will only use the coaching service no more than 1 to 4 times a year.

__________________________________________________________________

* Required fields
Name *
E-mail Address *
Town & State *
Phone Number *
Number of Children *
Child 1- Diagnosis *
Child 2 - Diagnosis
Child 3 - Diagnosis
Child 4 - Diagnosis
Child 5 - Diagnosis
If you answered "Other" to questions 4 - 9, please elaborate.
Please list, according to above numbers, name, age, medications & dose of each child. *
Please tell me a little about yourself and your family; particularly how the diagnosis of ADD has affected all of you. *
Please tell me what your concern is at this time. Be specific as to what you would like to focus on during our session. *
Preferred Day of Consultation *
Preferred Time of Consultation *

I have read and agree to the Privacy Policy *

Spam prevention


Please enter the code shown above and click the 'Submit Form' button. This additional step is required to help protect against message spam.

Enter code above:


If you have one very specific question, that can be answered via email, go to the One Time Response Email Form.

 

Guest Book  Recommend  Site Index