ADHD/ Behavioral Initial Appointment

ADHD/ Behavioral Initial Appointment
This office can provide ADHD evaluations for most new and current patients. This process is structured and consists of an initial interview with the parent(s) and a thorough review of rating scales from teachers and parents.

This is generally followed by a developmental assessment of the child with treatment recommendations based on the previous assessments. If medication is deemed appropriate, the doctors are also able to prescribe the correct medications.

This process requires the parents to commit to a contract to complete the evaluation. Children with complicated emotional and mental health issues may be referred to a child and adolescent psychiatrist as well.
Patients Full Name*

First NameLast Name
Date of Birth*
Who is your Provider *
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
If you need to download the forms, please click the link to redirect you to our website where the forms are available for download.

WWW.PEDIATRICSAROUNDTHEBEND.COM
This checklist is for you to make sure all the documents you need to complete this form are done and ready to submit.

Parent Vanderbilts

Please attach the vanderbilt forms for each parent. In most cases there should be 2.
File Upload*

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If 2 parent vanderbilts are not uploaded, please include the reason. If this does not apply to you, please type "NA"*

Teacher Vanderbilts

Please attach the teacher vanderbilts. There should be one per core curriculum.
File Upload*

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If you are working with someone in the office please include their name.
Allow 24-48 hours for the office to review your documents.

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Signed Contract