Northwest ADHD Treatment Center - New Patient Referral Form Logo
  • New Patient Referral Form

    Northwest ADHD Treatment Center only accepts referrals from medical and mental health care professionals.
  • ***Please be aware that our waitlists may close. Check our website and consider wait times before referral submission***

    https://nw-adhd.com/patient/ (scroll down the page to view waitlist times)
  • Waitlist Information

    The following questions will be used to determine if our waitlists are presently open or closed for the referral you would like to submit. If the waitlist is closed, please check our website for updates.
  • Based upon the information that you have entered, our waitlists are currently closed. Please check our website for updates.

  • Referring Provider Information

  • Patient Information

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    • Expand to add a Patient Guardian/ Authorized Representative 
    • Patient's Guardian/ Authorized Representative Information

      The following section only needs to be completed if someone other than the patient has legal authority to schedule appointments and make care decisions about the patient. This includes parents if a patient is a minor.
  • Patient Insurance Information

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  • Referral Information

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