Intake form

Name *

Email address *

What neurodivergent conditions do you identify with?

Please select at least one option.

Autism Spectrum Disorder

Attention Deficit Hyperactivity Disorder (ADHD)

Dyslexia

Dyscalculia

Tourette Syndrome

Anxiety Disorders

Bipolar Disorder

Obsessive-Compulsive Disorder (OCD)

Sensory Processing Disorder

Other (please specify)

What specific cognitive needs do you wish to address?

How did you hear about mind mate?

What type of support are you seeking?

Please select at least one option.

Guidance on daily tasks

Emotional support

Cognitive skills training

Stress management

Time management

Other (please specify)

Have you previously used any neurodivergent assistance apps?

What is your preferred method of communication?

What is your age group?

Which service or services are you interested in?

Please select at least one option.

Personalized cognitive modules

Interactive learning tools

Community connection features

Additional questions or comments

Mind Mate