Your Interest in a Mindfulness-based Approach to Cultivating Attentiveness

Thanks for taking a minute to tell us a little more. This will help us be more ready for our video consult.

Question Title

* 1. Tell us a little about what motivates you to reach out for this consultation?

Question Title

* 2. If you're open to it, we'd be interested in hearing some of your story and background individually or as a family connected to this issue of attentiveness and inattentiveness.

Question Title

* 3. Are you - or the person you are reaching out for - currently receiving medical treatment in attempt to address inattentiveness or other behavioral struggles?

Yes

No

Question Title

* 4. Have you - or the person you are reaching out for - practiced mindfulness in any serious way to this point?

Yes

No

Question Title

* 5. Is there anything else we should know about your situation that would be helpful to us better supporting you or your family?

Question Title

* 6. Are there any other questions or concerns we should know about that would be important for us to hear in advance?