Adult ADHD Contact Us Form “*” indicates required fields Thank you for taking the time to let us know any changes in your circumstances since you were initially referred for an ADHD assessment. If you have not been referred for ADHD yet, please speak to your GP first. You can find additional information regarding ADHD here. Do you want to remain on the NHS ADHD waiting list?* Yes – Keep me on the list No – Remove me from the list Please be aware that these forms are not-monitored daily and are predominantly for updating our records. We may write to you in response to this form to advise of any changes made or recommendations. If your needs are of a clinical nature, or require a quicker response, we recommend you contact the relevant team by phone, they can be contacted via the phone numbers below : East Suffolk: 01473 279200 West Suffolk: 01284 733188 Norfolk and Waveney: 01603 974683 Thank you. You don’t need to do anything else. You will stay on the ADHD waiting list. If your needs are of a clinical nature, we recommend you contact the relevant team by phone, they can be contacted via the phone numbers below : East Suffolk: 01473 279200 West Suffolk: 01284 733188 Norfolk and Waveney: 01603 974683 You can find additional information regarding ADHD here. My detailsWhich adult ADHD team you have been referred to?* East Suffolk West Suffolk Norfolk and Waveney Name* First Last Date of Birth* Day Month Year RMY Number Optional OptionalIf known.NHS Number Optional OptionalIf known.Your Phone*Your Email* Enter Email Confirm Email If you would be interested in some information regarding NSFT Recovery College or NSFT Wellbeing services please tick this box and you will be sent some additional information/links Yes Optional Optional How can we help you?* I have been referred/diagnosed/medicated by another service and understand that this means I come off the NHS waitlist I wish to come off the waitlist for another reason I have been referred/diagnosed/medicated by another service providerHow was the diagnosis funded?* Right to choose Self funded Do you know who your provider is?* Yes No Provider Name*Provider Address Address Line 1 Optional Optional Address Line 2 Optional Optional Town/City Optional Optional County Optional Optional Post Code Optional Optional Provider Phone Number Optional OptionalProvider Email Address Enter Email Optional Optional Confirm Email Optional Optional If you have a copy of your diagnostic report, please upload a copy here Optional Optional Drop files here or Select files Accepted file types: pdf, docx, jpeg, jpg, Max. file size: 10 MB, Max. files: 1. I wish to come off the waitlist for another reasonWhy do you want to leave the waiting list?* Check your answers{all_fields}