Do you currently have a child diagnosed with ADD or ADHD, OR experiencing symptoms? *

Yes

No

First Name *

Last Name *

Email *

Phone *

What state do you live in?

What challenges is your child currently experiencing? (Select all that apply)

Difficulty Focusing

Emotional Outbursts

Sleep Struggles

Side effects of medication

Gut / Digestive issues

What are your child's/ children's current age (s)?

Please select the option below that best describes your child’s current situation:

It’s very important that all decision-makers involved with solutions for your child’s health are present for our call, please confirm below: