Referring a Patient


Seeking Help for Someone You Know

If there is someone you know whom you believe to have ADD/ADHD, you have taken the first step to helping him or her achieve a healthier and more productive life. There are valuable resources and treatment programs available. There is hope, even if other treatment options were tried in the past without success.

There are two easy ways to refer a patient for an evaluation. You can make the initial inquiry via email or phone to gain insight into the process. If you email the office, we will contact you via phone to discuss your request. While you can’t force a person to get help, you can jump start their ability to do so by leading them to available resources and organizing the initial steps for them. You can also encourage the patient fill out the New Patient Request Form directly.

To contact us by telephone, Call 410-583-2726. Staff are available Monday – Friday, 8:30 a.m. to 5:00 p.m.

Form Title
  • Contact Information (Your contact information, not the prospective patient)
    0
  • First Name*
    1
  • Last Name*
    2
  • Relationship to Patient*
    3
  • E-mail*
    4
  • Daytime Phone*
    5
  • Alternate Phone*
    6
  • Best Time To Contact You
    7
  • Day of Week*
    8
  • Time*
    9
  • Contact Phone Number*
    10
  • Describe Situation*
    11
  • Captchacopy the words
    12
  • 13