Current Groups

Name *

First Name

Last Name

Phone *

(###)

###

####

Preferred Contact Method *

Text, Call, or Email?

Text

Phone

Email

What group are you interested in?

ADHD Support & Accountability Group

Insurance or Self-Pay? *

Insurance

Self-Pay

How would you like to proceed? *

Would you like for us to go ahead and send you the consent forms or would prefer to gather more information first?

You may email me the forms

I still have a few questions that I prompted in the 'message' box