Focus Now | SimplePractice

Who would be receiving care?

Someone else

Your info

First name

Last name

Phone

Name you go by

Date of birth

Gender

Sex at birth

For insurance verification

State

Select the state you live in

Billing & Payment

Payment method

How do you plan to pay?

Administrative

Please review before submitting your request

This service is designed for adults seeking ADHD-focused care. We are not able to provide treatment for individuals experiencing active suicidal thoughts, psychosis, severe mood instability, or conditions requiring in-person or higher-level psychiatric care. All submissions are reviewed before scheduling. If appropriate, you will receive next steps within 24–48 hours. If not, you will be advised to seek in-person care. Type "I understand" to continue.

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For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.