Oakdale ADHD Medication Service Opt In Form

Reason for Referral

Please tell us in your own words why you are referring yourself / your child to request ADHD medication. What impact is your / your child's ADHD having at present? You might want to include information about your / your child's access to work or education, relationships, social life, and home life.

Privacy and Confidentiality

Please click here to access Oakdale’s Privacy Notice.

By submitting this form, you confirm you have read the Oakdale Privacy Notice and consent to Oakdale having this information on file to deal with your referral request.

If you are submitting this form on behalf of your child or young person aged 14+, we would expect that you have discussed this with them and that they are consenting to the opt-in and aware of what it is for.

On the email sent to you from Oakdale there should be an enclosed password, please provide that password now. We also require confirmation of your email address and preferred telephone number for the purpose of progressing your referral.

If you have any difficulties with your password, please email us at adhdmedication.admin@oakdalecentre.org with your / your child's name and we will help you.

On submitting this form, your opt-in will be reviewed, and we will contact you to collect updated contact information and (if you were diagnosed with ADHD by Mantle or Evolve) a copy of the diagnostic report.