ADULT ADHD SCREENING AGREEMENT 

Medical Information 
Medication 
I strongly recommend that you discuss with your GP your intention to have a private ADHD Assessment. This means that any questions or concerns your GP may have, can be addressed at the outset. 
Information about Adult ADHD Screening 
 
Questionnaires to be completed and returned the day before our appointment at the latest 
An online screening appointment lasting approximately 45 minutes 
 
Fees and Cancellations 
 
The fee for your screening appointment is £90. 
 
If you cancel the appointment with less than 48 hours’ notice, there is a £45 cancellation fee. 
 
Payment to be made by bank transfer to: 
Account Name: Jennifer Susan Arthern 
Account Number: 6586 0873 
Sort Code: 40-47-67 
 
 
Criteria for the diagnosis of Adult ADHD 
 
For a diagnosis of ADHD to be made, symptoms should: 
 
meet the diagnostic criteria in The Diagnostic and Statistical Manual of Mental Health Disorders V 
the symptoms of hyperactivity/impulsivity and/or inattention need to cause at least moderate psychological, social and/or educational or occupational impairment based on interview and/or direct observation 
be pervasive, occurring in 2 or more important settings including social life, family, school or work settings 
 
Confidentiality 
 
Like all psychologists I am required to have regular clinical supervision and may take to supervision anything which we discuss in your assessment. The aim of supervision is to ensure that I provide the most effective service for you. 
When required by law, which is very rare. 
I may contact your GP or other professionals involved in your care if I believe that there is a risk of serious harm to yourself or others. This includes issues relating to the safeguarding of children and vulnerable adults. 
I am registered with the Information Commissioner’s Office, and I understand General Data Protection Regulation and abide by this for the storage of all data. Information held digitally is encrypted. 
 
Professional Registration 
 
I am registered with the Health and Care Professions Council (HCPC). If you have a complaint against me which it has not been possible for us to resolve through discussion, then please contact HCPC: Tel: 0800 328 4218 Email: ftp@hcpc-uk.org 
 
 
I have read the above information and would like to book an ADHD Screening Appointment with Jenny Arthern, HCPC Registered Psychologist.