ADHD Consent Form CYP Consent to ADHD Assessment and Treatment This form is to obtain consent for ADHD assessment and potential treatment.Patient InformationFull Name of Child/Young Person:(Required)Date of Birth (DD/MM/YYYY):(Required)NHS Number (if known):Parent/Guardian Name(s):(Required)Relationship to Child/Young Person:(Required)Contact Telephone Number:(Required)Contact Email Address:(Required) Consent to Assessment and TreatmentConsent(Required) I confirm I have parental responsibility for the above-named child/young person and consent to an ADHD assessment, which may include interviews, questionnaires, and observations.(Required)Consent(Required) I agree to the sharing of relevant information with involved professionals to aid in assessment and care planning.(Required)Consent(Required) I consent to the proposed treatment plan should an ADHD diagnosis be confirmed. This may include behavioral support, coaching, and/or medication.(Required)Consent(Required) I understand that any medication prescribed will be explained, including benefits, side effects, and importance of adherence.(Required)Consent(Required) I understand that some appointments may be conducted online, and I have access to a suitable device and private internet connection for this purpose.(Required) Information Sharing Consent Please tick to confirm your consent for the following:Consent(Required) I consent to information being shared with my child’s school to support educational needs.(Required)Consent(Required) I consent to information being shared with my child’s GP to coordinate care.(Required) Safeguarding and Confidentiality All personal data will be handled in line with the Data Protection Act 2018 and GDPR. Information is confidential unless there is a concern about the safety or wellbeing of your child or others. If any risk is identified, ADH-ME has a legal and ethical obligation to report concerns to the appropriate local safeguarding team or social services. Right to Withdraw Participation is voluntary. You may withdraw your consent at any time. Doing so will not affect any care already provided. SignaturesParent/Guardian Signature:(Required)Clinician Name(Required)Choose an optionRyan WilliamsDate(Required) MM slash DD slash YYYY consent(Required) I consent and agree to Mental Health Assessment/Treatment(Required)Agree(Required) I agree for this form to be sent to the Associated Therapist(Required)Terms & Conditions(Required) I agree to terms & conditions and Privacy Policy (Required)CAPTCHA
