QbTech (QbCheck) Patient Testing Checklist

  • QbTech (QbCheck) Patient Testing Checklist

    Please review and acknowledge each item below before beginning your assessment. These requirements are necessary to ensure accurate results and avoid interruptions.
  • 1. Technology & Environment Requirements (Must be completed before testing) To complete the assessment successfully, I confirm that:*
  • 2. Health & Readiness Check*
  • 3. Medication & Substance Guidance*
  • 4. Test Expectations*
  • 5. Follow-Up and Results Review*
  • 6. Test Integrity & Patient Certification*
  • 🟢 Ready to Begin By proceeding, I confirm that all checklist items are complete and that I meet the requirements to begin the QbTech (QbCheck) ADHD assessment.

  • QbTech ADHD Testing Financial Responsibility and Patient Acknowledgment Form

  • QbTech ADHD Testing: What Patients Should Know

    Accurate diagnosis is essential to effective ADHD treatment. QbTech is an FDA‑cleared, computerized testing system used worldwide to support clinical evaluation of attention‑related symptoms. It provides objective data that complements clinical interviews, rating scales, and professional judgment.

    QbTech testing is not a diagnosis by itself but offers valuable information that helps your provider better understand attention, impulsivity, and activity patterns over time.

    Benefits of QbTech Testing

    • Provides objective measurement of attention and activity
    • Supports a more thorough and accurate evaluation
    • Helps distinguish ADHD symptoms from other conditions
    • Assists with treatment planning and monitoring response over time
    • Reduces reliance on subjective reports alone

    QbTech testing is used as part of a comprehensive evaluation, which may also include a clinical interview, review of history, rating scales, and follow‑up visits.

    No Guarantee of Medication or Treatment

    I acknowledge that completing QbTech testing does not guarantee that I will be prescribed medication or receive any specific treatment. All diagnostic and treatment decisions are made solely by my provider based on clinical judgment and professional standards of care.

    Insurance Verification and Financial Responsibility Agreement

    The practice will make reasonable and good‑faith efforts to verify insurance eligibility and benefits when possible. However, verification of benefits is not a guarantee of payment by the insurance carrier.

    I understand and agree to the following:

    The total cost of QbTech testing is $275, which is required prior to testing due to third‑party testing costs.

    Third‑Party Testing Cost & Direct Payment Waiver (QbTech)

    This Waiver is entered into by the undersigned patient (or legal representative) and Diamond Global Healthcare Inc regarding objective ADHD testing using QbTech technology.

    Third‑Party Cost Disclosure

    I acknowledge that QbTech is a third‑party company separate from Diamond Global Healthcare Inc and that the practice incurs a direct cost for each QbTech test administered. Due to this third‑party expense, direct patient payment is required prior to testing.

    Superbill Disclosure

    After payment, a superbill may be provided upon request for self‑submission to my insurance carrier. I understand that submission of any superbill is my responsibility and that reimbursement, if any, is determined solely by my insurance carrier.

    Voluntary Agreement and Informed Consent

    By signing below, I confirm that:

    • I have read and understand the information provided in this document.
    • I have had the opportunity to ask questions prior to signing.
    • I understand the financial responsibility associated with QbTech testing.
    • I understand that declining QbTech testing does not prevent me from receiving other clinically appropriate care.

    This Waiver does not waive my rights to informed consent, quality care, or professional standards of practice.

  • Date*
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