New Patient Request Form

New Patient Request Form

Becoming a New Patient

Thank you for your interest in becoming a patient with Northwest ADHD Treatment Center! We are striving daily to meet the needs of as many patients as we can, but the demand for our services is high. Please complete the following information and our Intake Coordinator will reach out to you soon. Depending on the complexity of your needs we may refer you to other providers in the community.

Please note: we are not an urgent, crisis, or emergency facility. If you are having a mental health crisis or emergency please go to the emergency room or contact your county crisis line. Do not communicate urgent, crisis, or emergency needs or concerns via this form.