• Assessment Referral Application

    For Self-Funding Applicants Only.

  • About This Form

  • To ensure an assessment and referral from AuDHD UK is appropriate for you, we need to know a little bit about you, your health, and some other aspects of your life. This helps us and our clinical partners get a more accurate idea of why you are seeking an assessment and how we can help. 

    It is not necessary for your responses to be extremely detailed for us to make a decision; what is important is that you give us a good, rounded picture of your day-to-day life/experiences.

    It is not a test. There are no wrong answers.

  • Important Information

  • This is a self-funded assessment application. Please make sure you have reviewed current pricing on our website before submitting your application: View Pricing. Please note we do not offer split payments / instalments; payment must be made in full and in one transaction within 14 days of being sent the payment link.

    In order to protect the health and wellbeing of those working for AuDHD UK, we ask that you please do not send additional information to us via email or by any other means unless explicitly asked to do so.

    Please note your responses will be kept safe and confidential, and will only be shared with your consent or, in rare cases, if we have serious safeguarding concerns; please see our Safeguarding Policy for more information.

  • Personal Details

  • Date of Birth*
     / /
    2 digit day, 2 digit month, 4 digit year
  • Preferred Pronouns*

  • Brief History

  • Are you, or do you think you are, autistic?*
  • Are you, or do you think you are, ADHD?*
  • Are you on the waiting list for an autism/ADHD assessment through the NHS or local services?*
  • Do you have any family members with diagnosed neurodiversity (e.g. autism, ADHD, dyslexia, dyscalculia)?*
  • Are you diagnosed with any other neurodivergences or co-occurring conditions, such as dyslexia, dyspraxia, or Ehlers-Danlos Syndrome?*
  • Have you previously been assessed for autism/ADHD and were not diagnosed?*

  • Assessment Details

  • We offer 3 different assessment pathways:

    • Combined AuDHD assessment- assesses for both autism and ADHD at the same time
    • Autism assessment- assesses for autism only
    • ADHD assessment- assesses for ADHD only

     If you have an existing diagnosis of either autism or ADHD, you do not need to apply for the AuDHD pathway unless you would like an updated diagnosis for these.

  • Which assessment are you looking to have?*
  • Have you been advised by a healthcare professional to seek this assessment?*
  • Do you have a preferred format for your assessment?*
  • Do you have a preferred assessment provider?*

  • Declaration & Consent

    You can read our policies at audhduk.org/policies.
  • I confirm that I am aged 18 or over and live in the UK.*
  • I confirm that the information provided is accurate to the best of my knowledge.*
  • I acknowledge this is a self-funded assessment and have reviewed current pricing on AuDHD UK's website.*
  • I understand payment must be made in full within 14 days of being sent the payment link.*
  • I consent to my information being used for the purposes of assessing my application and for safeguarding, in line with AuDHD UK's policies.*
  • I consent to my responses being shared with AuDHD UK's clinical partners for the purposes of my referral and assessment.*
  • Should be Empty: