Get Started
A quick fit-check before we schedule.
Tell Us About You
Name
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First Name
Last Name
Date of Birth
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Phone Number
*
Format: (000) 000-0000.
Email
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
State of Residence
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Please Select
Colorado
North Carolina
Other (I live somewhere else)
We're only licensed in Colorado and North Carolina right now, so we can't see you as a patient. Thank you for reaching out.
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I acknowledge Falcons ADHD Plus is a cash-based practice. We do not bill insurance for appointments or labs. If your insurance covers medications at a local pharmacy, we can submit a prior authorization.
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I acknowledge Falcons ADHD Plus is a 100% telehealth practice. All visits are over secure video.
Services you're interested in
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ADHD evaluation or treatment
GLP-1 / weight management / metabolic health
Hormone optimization
Peptide therapy
Not sure yet
In a few sentences, what's going on and why are you reaching out now?
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A Few Quick Questions
In the last 30 days, have you had thoughts of hurting yourself or someone else?
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Yes
No
Have you ever been diagnosed with schizophrenia, schizoaffective disorder, or Bipolar I disorder?
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Yes
No
This form isn't read in real time. If you're thinking about hurting yourself or someone else, call or text 988 (Suicide and Crisis Lifeline) or call 911 now.
In the last 30 days, have you had a mental health crisis?
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Yes
No
In the last 30 days, have you been in the hospital for your mental health?
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Yes
No
Are you currently experiencing psychosis, hallucinations, or delusions?
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Yes
No
Are you currently receiving controlled substance prescriptions (including for opioid use disorder, chronic pain, anxiety, or sleep) from another provider?
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Yes
No
Have you ever been dismissed from care by a provider for medication misuse, diversion, or not following treatment?
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Yes
No
Have you ever been diagnosed with a personality disorder (such as borderline, antisocial, narcissistic, or histrionic personality disorder)?
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Yes
No
I'm not sure
Are you currently taking a benzodiazepine (such as Xanax, Klonopin, Ativan, or Valium) on a daily or near-daily basis?
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Yes
No
How soon would you like to be seen?
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This week
Within 2 weeks
Within a month
No rush
List all medicines you take, including over-the-counter medicines and supplements. Include the dose and how often you take each one. If none, write None.
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Best days of the week for an appointment
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Best time of day for an appointment
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Morning
Afternoon
Evening
Any time
Based on your responses, Falcons ADHD Plus may not be the right fit for your needs. We appreciate your honesty — it's how we keep care safe for everyone. We encourage you to connect with a provider who specializes in your situation. If you are in crisis, call or text 988 or call 911.
About Your ADHD
Have you ever been diagnosed with ADHD?
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Yes
No
Are you taking an ADHD medicine now?
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Yes
No
Check any that apply to you:
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Heart problems
Chest pain
Fainting
High blood pressure
A family member died suddenly of a heart problem before age 50
None of these
Are you pregnant, breastfeeding, or planning a pregnancy?
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Yes
No
Doesn't apply to me
Have you ever taken a stimulant in a way it wasn't prescribed?
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Yes
No
Are you OK with monthly visits for the first 3 months?
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Yes
No
Referral Source and Additional Notes
How did you hear about us?
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Please Select
Google search
Instagram
Referral from a current patient
Referral from another provider
Podcast or article
Other
Anything else you'd like us to know?
Agreements
I consent to receive text messages from Falcons ADHD Plus at the phone number provided. Message and data rates may apply. Message frequency may vary. Reply STOP to opt out. Reply HELP for help.
Would you like us to follow up with you by text or email about next steps?
Yes, please follow up
Pricing
Cash-pay, no insurance
First visit: $350
Months 2 and 3: $250 per visit
After month 3, you choose: pay as you go at $250 per visit, or a $149/month membership
Signature
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See If I Qualify
See If I Qualify
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