Self Referral Form for ADHD Medication

Ages 11 to 65 years

This Self Referral Form is for patients seeking ADHD Medication, privately funded.  Please see our below eligibility criteria prior to completing this form. For information on the process please see our Medication page.

Self Referral Form for ADHD Medication

Ages 11 to 65 years

This Self Referral Form is for patients seeking ADHD Medication, privately funded.  Please see our below Eligibility Criteria prior to completing this form. For information on the process please see our Medication page.

Coming Soon!

Please revisit as we are launching early January 2026