Intake form

Tell us about your student.

This takes about 5–7 minutes. We'll follow up within two business days to schedule a free 20-minute discovery call. Only your contact info is required — everything else helps us prepare.

Parent / guardian information

Who should we contact to get started?

Parent / guardian name *

Relationship to student

Email *

Phone *

Best way to reach you

How did you hear about us?

Student information

A few basics about the student we'd be working with.

Student's first name *

Student's last name

Student's age *

Current grade

School name

School type

Pronouns (optional)

Does the student know you're reaching out?

Diagnoses & medical background

Only share what you're comfortable sharing — this helps us prepare, not qualify.

ADHD diagnosis?

Other diagnoses (if any)

Current medications (optional)

Currently working with a therapist or clinician?

Other relevant medical or developmental history

Academics

This helps us understand where the student is right now.

Does the student have an IEP or 504 plan?

Recent overall academic performance

Strongest subjects

Most challenging subjects

Recent standardized test scores or assessments (optional)

Teacher comments or recommendations (optional)

Executive function & goals

The 'why now' — what's prompting you to reach out?

Which areas feel like the biggest challenges right now?

Getting started on tasksFinishing tasksTime managementPlanning aheadOrganization (physical and digital)Working memory / forgetting thingsEmotional regulationFlexibility / handling changeSelf-advocacySleep / morning routines

What does a hard week look like at home?

What would 'coaching is working' look like in 3–6 months? *

Anything else we should know?

Logistics

Last few things so we can plan a discovery call.

Preferred session times

Time zone

When would you like to start?

Are you working with a pediatrician who referred you?

By submitting, you agree we may contact you about scheduling a discovery call. We never share your information.

P.A.V.E. ADHD Coaching

One-on-one executive function coaching for teens and young adults, including students with ADHD.

Explore

Home
Services
How it works
About
Intake form

Get in touch

hello@paveadhdcoaching.com
Mon–Fri · Virtual sessions nationwide

Edit with