Leucovorin Decision Tree

We’ve designed this program to be as accessible, affordable, and flexible as possible—especially for families managing complex needs like autism and speech delay.

Instead of charging per visit or message, we use a monthly subscription model that supports both synchronous and asynchronous care. This reduces cost for families who need minimal clinical time, while still allowing those who need more support to access it affordably.

Your subscription includes:

• A brief virtual tele-appointment to start care (first 5 minutes fully included)
• Monthly leucovorin prescriptions and dose adjustments as clinically appropriate
• Continuous access to our internal resources and guides covering common questions
• A printable info packet for your local provider
• The ability to request more live clinical time if needed (see costs below)

Subscription cost:

• $350 for the first month
• $175 for the second month
• $75/month ongoing

Additional live time (beyond included 5 min):
$900/hour, billed in 5-minute increments 

The initial virtual tele-appointment ensures:

• We confirm your identity
• You’re aware of key treatment decisions (e.g., FRAT testing, dosage, and side effect planning)
• You feel supported in assessing whether this path is right for your family

We’re committed to making this process simple, cost-effective, and transparent—no hidden fees, no surprise bills.

Identity Verification

Please upload a photo of yourself (patient or caregiver filling out this form) holding your government-issued ID (e.g., driver’s license) next to your face.

Instructions:

• Must show your face and full name on ID clearly
• Required for legal and licensing verification

Who is the one medical provider currently managing your child’s autism and mental health-related care?

Communication with Your Child’s Provider (Required to Proceed)

If leucovorin is clinically indicated, Dr. Danish and his team will send your child’s provider a detailed written note outlining the treatment plan—including the rationale behind leucovorin, relevant research, and a list of potential side effects to monitor.

In most cases, this written communication is sufficient. We also make it easy for your provider to email us with any questions or concerns. However, some providers may still request a direct phone conversation.

Please note:
If your child’s provider requests a phone call, Dr. Danish is professionally and ethically obligated to respond. These calls fall outside the scope of the monthly subscription and are billed separately at his standard pro-rated clinical rate. This policy is non-negotiable.

Thank You for Your Submission

At this time, we’re unable to move forward with leucovorin treatment because you did not consent to allow Dr. Danish to communicate with your child’s provider if they reach out with questions.

In order to ensure safe, ethical, and collaborative care, we require this permission before proceeding.

If you made this selection in error, you can hit Back to update your response.

Otherwise, if you change your mind in the future, you're always welcome to return and restart the intake process.

Warmly,
Dr. Danish & Team

Some families have already completed labs that explore genetic, metabolic, or mitochondrial factors influencing development, mood, or response to treatments. These tests aren’t required for leucovorin treatment but can offer helpful context—especially in complex or supplement-sensitive cases.

Important Note on Seizure History

Thank you for sharing this information. Leucovorin is generally well tolerated, but in rare cases, it may increase seizure frequency—especially in individuals with epilepsy or underlying metabolic conditions.

While most studies do not show a significant seizure risk, we take added precautions when there’s a history of seizures.

To proceed safely, please upload a brief note from your child’s neurologist or PCP stating that:

• They’re aware of the seizure history, and
• They have no objection to starting leucovorin with appropriate monitoring.

An informal message or chart note is sufficient.

Please briefly describe your child’s developmental, behavioral, and neurological history—so we can better understand the clinical picture and the reason for your interest in leucovorin.

• If you’ve already uploaded official diagnostic documentation that covers these areas, feel free to write “See uploaded records” in the box below. 
• Questions about ADHD, anxiety, and other mental health concerns will follow on the next slide.

You may include details in the following areas (as applicable):

• Motor development: Delays in crawling, walking, or fine motor skills?
• Communication: Nonverbal status, regression, echolalia, or other language concerns?
• Social skills: Challenges with peer interaction, pretend play, or joint attention?
• Sensory processing: Over- or under-reactivity to sounds, textures, lights, etc.?
• Behavioral patterns: Repetitive behaviors, rigidity, meltdowns, or other notable patterns?
• Academic/cognitive functioning: Learning disabilities, global delays, IEPs?
• Family History: Any family history of developmental conditions?

This is an optional blood test that checks for folate receptor autoantibodies—proteins that can block folate from entering the brain. These antibodies are sometimes found in individuals with autism, developmental delays, or speech/language challenges. In such cases, folinic acid (leucovorin) treatment may be especially helpful.

However, this test is not required to begin treatment. We often prescribe leucovorin based on clinical symptoms alone.

⚠️ Things to Know Before You Decide:

• Positive test → May support the decision to start leucovorin
• Negative test → Does not rule out the possibility of benefit
• Result turnaround: About 2–3 weeks from the time the sample is mailed back
• Cost: ~$295 flat fee (includes return shipping; typically not covered by insurance)
• Our clinical practice: Most children we treat don’t get this test, as it rarely changes the treatment plan and can delay care

You might consider testing if:

• You prefer lab confirmation before starting treatment
• Your child has significant developmental delays or autistic traits
• You're comfortable navigating the extra logistics and cost

We’ll mail the FRAT kit directly to your home.

You’ll need to arrange a local blood draw. Most Quest and Labcorp locations do not offer this service, so be sure to confirm in advance. The lab may charge a separate fee for the blood draw.

You can share these official blood draw instructions with your chosen lab.

Need help finding a nearby lab? Contact FRATNow at info@fratnow.com or (610) 441-9050.

⚠️ Blood draws can be challenging for some individuals, especially those with sensory sensitivities.

Before we proceed, please confirm that you have reviewed the educational materials and agree to the terms of this asynchronous care model. These acknowledgments are required to ensure informed consent and protect your family's privacy.

Leucovorin Treatment Acknowledgment & Monitoring Summary

• I have reviewed the educational materials available at DrDavidDanish.com, including information on how leucovorin may support individuals with autism, speech delays, or related developmental concerns.
• I understand that leucovorin is not FDA-approved for autism spectrum disorder or speech delay, and that the evidence base is still evolving. This treatment is being offered based on emerging research and clinical experience.
• I understand that this care model begins with a brief virtual intake appointment (up to 5 minutes) with Dr. Danish or a licensed clinical provider. This visit constitutes the formal start of care. Any additional time beyond this will be billed separately based on a prorated schedule.
• I understand that leucovorin is generally well tolerated, but may cause side effects such as irritability, hyperactivity, sleep changes, or gastrointestinal discomfort. I agree to monitor for these and contact the team if they arise.
• I acknowledge that although rare, there may be increased risks in individuals with seizure disorders or unrecognized metabolic conditions. I confirm that I have shared all relevant medical history to the best of my ability.
• I understand that in certain situations, it may be helpful to pursue metabolic or genetic testing before starting treatment. Testing may be especially worth discussing with your provider if:

• Your child has had seizures or unexplained episodes of loss of skills
• There is a history of distinct developmental regression after a period of typical growth
• Your child experiences chronic fatigue, energy crashes, or frequent illness
• There are known or suspected genetic or mitochondrial conditions in the family
• Past trials of supplements have triggered irritability, agitation, or fatigue

• I understand that the prescription I receive is based solely on the information I have submitted and the educational content I have reviewed. No in-person medical examination has been performed.
• I understand that if a longer or follow-up consultation is needed, it will be billed at $500 per 25-minute session due to limited provider availability.
• I understand the initial starting dose and the recommended titration plan. I will follow the instructions provided and reach out if I have questions.
• I have recorded my child’s most recent height and weight to support safe dosing.
• I have made a note of all current supplements, especially those that may interact with folate metabolism (e.g., carnitine, CoQ10, methylfolate, or B12).
• I have discussed optional FRAT testing with the care team and understand that it is not required to initiate treatment.
• I understand that I may reach out to the team at Philadelphia Integrative Psychiatry or consult with my local provider if I observe any of the following concerning symptoms:

• New or worsening seizures
• Severe or prolonged irritability or behavioral regression
• Loss of previously acquired developmental skills
• Persistent fatigue interfering with daily function
• Refusal to eat or significant unintended weight loss

• I authorize the release of relevant medical information to the provider I listed earlier for care coordination purposes.
• I consent to being contacted by my selected method (text, phone, or email) for updates and follow-up related to this care.
• I authorize secure storage of all submitted materials—including ID verification, videos, and medical documentation—for clinical and regulatory purposes.