First Name *

Last Name *

Email Address *

Residential address *

Street address *

City *

State *

Postcode *

How old are you? *Please note the service is only suitable for patients over the age of 18

Are you an exisiting patient at Whitebridge Medical Centre? *

YesNo

Have you been formally diagnosed with ADHD? *

YesNo

Are you currently taking medication for your ADHD? *

Yes No

Who is currently prescribing your medication for your ADHD? *

A psychiatrist A GP Someone else

Is your dose currently stable? *

Yes - I have been on the same dose for a while No - my dose is still being changed No - I'm still trialling different options with my prescriber

I'm not sure you need a medication continuation service if you're not on any medication?

Great! It sounds like you might be a fit for our ADHD continuation service! Only a couple more questions to go.......

Do you have any other mental health diagnosis? *

Yes No

Would you consider your non-ADHD diagnosis to be complex? *

Yes No

Do you have any other non-mental health conditions? *

YesNo

Can you tell us more about your other mental health conditions? *

Can you tell us more about your non-mental health conditions? *

Is there anything else you'd like to tell us before submitting your form? *

Unfortunately you do not meet our prescribing criteria for the ADHD continuation service - in order to access the service you need to be over 18, formally diagnosed by a psychiatrist and be on stable treatment. We apologise that we cant help through this stream but welcome you to complete a new patient waitlist request for Whitebridge Medical Centre as a general practice patient to discuss options to help.

Unfortunately you don't meet our prescribing criteria for the ADHD continuation service - in order to access the service you need to be over 18, formally diagnosed by a psychiatrist and be on stable treatment. We apologise that we cant help through this stream but welcome you to complete a new patient waitlist request for Whitebridge Medical Centre as a general practice patient to discuss options to help.

Making sure you're not a bot.... *

The ADHD GP continuation service is not a bulk billing service. Fee's apply for all consultations. Fee schedules are avaliable through our website. Please acknowledge you are aware of our billing policy prior to submitting your form. *