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Provider Referral

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We’re here to partner with you

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Assessment Referral

We’re always accepting new patients via referral. Refer your patient or student to us for a formal ADHD Assessment by a licensed psychologist.

Treatment Referral

Complete a referral so your patient with an ADHD Online diagnosis can start or continue telemedicine treatment seamlessly. We’re always here to collaborate with you on the care of your patient.

The system is experiencing technical issues scheduling new appointments.

We apologize for any inconvenience this may cause you. We understand the importance of making an appointment, and this issue is our top priority.

Please reach out to us via chat or call us at 888-493-ADHD (2343) and we will assist you. If we are not available, please leave us a message and we’ll get back to you as soon as possible.

The ADHD Online Team

Provide this form to your local practitioner. You could:

  • Send this link
  • Email the pdf
  • Print it out and bring it to your appointment

Ask your practitioner
to complete the form

In this form, your practitioner will request that ADHD Online continue to provide uninterrupted care

Return the form to us

You or your practitioner can return this form to us via email or fax it to 616-210-3118