Online ADHD Assessment (18 and Younger) - Submittal Form

Welcome to the ADHD Assessment Submittal Form for individuals aged 18 and younger. This form is designed to collect basic information and you will receive a link for the test within 1 business day after payment submission.

Please follow the directions below to provide the necessary details.

Please provide your information as the parent or caregiver. This will help us get in touch with you to schedule the assessment.

Parent/Legal Guardian Information:

Legal Guardian

First Name

Last Name

Parent/Legal Guardian Email

Parent/Legal Guardian Phone

(###)

###

####

Preferred Contact Method

Phone

Email

Morning

Afternoon

Child/Adolescent Information:

Enter the information of the child or adolescent for whom you are seeking an assessment.

Child/Adolescent's Name

First Name

Last Name

Child/Adolescent's Date of Birth:

mm/dd/yyyy

Child/Adolescent's Gender:

Male

Female

Other

Thank you for providing this information. Your details are essential in helping us get in touch with you to schedule the assessment for your child or adolescent. If you have any urgent concerns or require immediate assistance, please contact our office directly.