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  • ADHD Information Form

  • We are pleased you have decided to take this step in seeking an assessment for ADHD. It is a corageous step.

    The questions below are designed to provide us with important information about you. Some questions may bring up some emotions, and some may not feel relevant to you. That is okay. 

    We ask for brief descriptions in these questions, and will go through relevant answers in more detail in the assessment process. 

    If there are any questions you are unsure of, please contact us on info@dianneeveritt.com, and we will be happy to guide you. 

     

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  • Developmental History

  • Educational and Work History

  • Family History

  • Mental Health History

  • Physical Health

  • Please read our terms and conditions. Our full terms and conditions can be found here. By checking the boxes below, you acknowledge that you have read the terms and conditions, and agree to them whilst working with any of the Clinical or Counseling Psychologists at Dianne Everitt and Associates. 

    Please take particular note of the following in realtion to fees and cancellation of sessions. 

    Cancellation Policy

    As ADHD appointments last between 2-3 hours, this is a significant amount of time that our Psychologists allocate to the assessment. These appointments are carefully planned and allocated, and we appreciate as much notice as possible should any changes be needed. 

    If you cancel the assessment within 48 hours, you will be charged £300.

    If you reschedule with less than 48 hours notice, you will be charged £100.

    If you fail to cancel the appointment, you will be charged £300.

     Settlement of Fees

    You will be liable for the settlement of fees, which can be paid by bank transfer following the receipt of an invoice.

    If you are using insurance to cover the cost of your sessions, please note that you need to obtain preauthorization before the first appointment, and there may be an excess for you to cover, depending on your policy. We will need confirmation from your insurer, stating they will cover the entire cost of the session, which is £1195. If they do not cover this, you will be liable for the full fee. 

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