Axis Enrolment - Connecting GPs and Psychologists
Welcome to Axis, the integrated ADHD care framework designed to support safe, efficient, and evidence-based ADHD identification and referral within primary care. This form enrols you (and/or your practice) in the Axis GP Training Programme and related services. It takes about 5 minutes to complete.
Section 1 – Participant Information
Please provide your details so we can set up your Axis account and CME records.
Name
*
First Name
Last Name
Contact Email
*
example@example.com
Contact Phone Number
*
-
Area Code
Phone Number
Practice Name
*
Practice Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Professional Role
*
Please Select
General Practitioner (GP)
Nurse Practitioner
Practice Manager
Other related role
NZMC Number
*
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Section 2 – Programme Details
This section helps us understand your current level of confidence and preferred learning format.
Which stream of Axis are you registering for?
*
Axis GP Training (1–2 hours, self-directed online or in-person)
Axis Treatment Workshop (90–120 minutes, practical session)
Full Axis Subscription (includes both training and workshop access)
How confident do you feel identifying ADHD in adult patients?
*
Not confident
Somewhat confident
Confident
Very confident
How familiar are you with ADHD diagnostic criteria and common comorbidities?
*
Not familiar
Somewhat familiar
Familiar
Very familiar
What is your preferred training format for learning to use Axis?
*
Self-directed online learning
Live virtual session
In-person workshop
Do you currently use any ADHD screening tools in your practice?
*
No
Yes (please specify)
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Section 3 – Access and Installation
This information helps us set up your Axis Portal and NeuroTap® screening system.
Preferred Email for Platform Access
*
(This will be your login for the learning platform and Axis Portal)
Do you use a shared practice email for clinical tools or software access?
*
No
Yes (please enter this email address)
What type of mobile phone will you primarily use to access the NeuroTap® system?
*
Apple (iPhone)
Android (Samsung, Google, etc.)
Other (please specify)
Where in your practice do you plan to use the NeuroTap® screening tool?
*
Consultation room
Nurse consult or assessment room
Shared space
Other (please describe)
Please list the number of rooms where you would like the NeuroTap® screening dot installed.
*
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Section 4 – Payment Details
Please provide the contact information for invoicing.
Name or department the invoice should be addressed to
*
(e.g. Practice Manager, Accounts Payable, Dr [Name])
Email address for invoice delivery
*
(This is where the Axis programme invoice will be sent)
Billing address (if different from practice address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Any special instructions for accounts or remittance notes (optional)
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Section 5 – Terms and Agreement
Before proceeding, please review the following statements.
Axis is a structured educational and clinical programme delivered by Studio Mindspace. Please confirm that you agree with the following statements:
*
Yes
No
I intend to participate in the Axis training and/or treatment workshop as part of a professional development programme.
I will uphold ethical standards in data handling, patient confidentiality, and use of clinical tools.
I understand that Axis tools are designed to support clinical decision-making and are not a substitute for formal psychological or psychiatric assessment.
I agree to Studio Mindspace storing relevant data in compliance with the Privacy Act 2020 and HIPAA standards.
Please enter your full name and date of enrolment to confirm your agreement with these statements.
*
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