Validation Study Form - ADHD Online

Validation Study Recruitment Form
Form ID
Name*

First NameLast Name
Email*
[email protected]
Mobile Phone Number*
Please enter a valid phone number.
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How old are you?*
Are you proficient in reading and speaking English?*

YesNo
Have you ever previously been diagnosed with ADHD?*

YesNo
Have you ever previously been diagnosed with schizophrenia, dementia, or a severe developmental disability (e.g., autism spectrum disorder)?*

YesNo
Were you referred specifically for an ADHD assessment by a provider or Mentavi?*

YesNo
Thank you for your time, unfortunately, you are not eligible to participate in this study. You may still be eligible to receive an ADHD assessment from Mentavi here: https://adhdonline.com/get-started
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Phone: 888-493-ADHD (2343)
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Contact us

Submit a request
Phone: 888-493-ADHD (2343)
Monday – Friday
9:00 AM – 5:00 PM EST

Company

More info

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If you have a concern about the safety and quality of care, please contact ADHD Online’s Chief Compliance Officer at compliance@adosandboxsite.

© 2024 Mentavi Health, Inc. All Rights Reserved. | Privacy policy | Notice of privacy practices | Terms & conditions | No Show & Refund policy

If you have a concern about the safety and quality of care, please contact ADHD Online’s Chief Compliance Officer at [email protected].

© 2024 Mentavi Health, Inc. All Rights Reserved. | Privacy policy | Notice of privacy practices | Terms & conditions | No Show & Refund policy