ADHD and/or Autism Evaluation Request

Primary Testing Coordinator

William Powell, MS, ALC, ADHD-PT

Patient First name

Patient Last name

Parent/Guardian First name

Enter NA if patient is over 18 years old.

Parent/Guardian Last name

Enter NA if patient is over 18 years old.

Primary Contact Email address

Primary Contact Phone number

Please describe your interest in an ADHD and/or Autism evaluation.

Important: You will receive an email with a link to complete the required documents and review necessary disclosures. Please allow 2-4 business days for this email. Once completed, you'll be contacted to schedule the intake session. The intake session is $200 and must be paid at scheduling.

Your information will be encrypted.

ADHD and/or Autism Evaluation Request

Primary Testing Coordinator

Primary Testing Coordinator

Ofaros LLC