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ADHD / ADD Assessment Submission Form

Date of Birth
Day
Month
Year

In order to progress towards an Initial Medical Assessment, you must firstly complete several questionnaires and provide details of your GP, your physical observations (Blood Pressure, Heart Rate, weight and height).


Please submit this form, or email drbensessa@gmail.com to progress with this referral. I will then send you the relevant questionnaires for completion.

NOTE: This information is confidential

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