ADHD PACKET INSTRUCTIONS

Dear Parents, 

This packet checklist has been prepared by our office in an effort to better evaluate your child for Attention Deficit/Hyperactivity Disorder(ADHD). Due to the Covid 19-Pandemic we have worked to make as much of this information online-fillable as possible. The staff then has to transfer your answers to a physical form that carbon copies your answers to a gradable paper format. These forms were creasted by Dr. C. Keith Conners, who is well known  for his studies in children's behavioral problems. There is a $5-10 charge to cover the cost of these forms.  

  1. Parent Vanderbilt - To share amongst both parents - please try to work together to complete the forms - if this is not possible please indicate which parent is filling out the form. 
  2. Parent Conners - To share amongst both parents - please try to work together to complete the forms - if this is not possible please indicate which parent is filling out the form. 
  3. Self Assesment Conners- Middle and High School Only
  4. CogAt scores (2nd grade cognitive abilities testing)
  5. Report Cards
  6. Itemized current class grade reports (middle and high school)
  7. IEPs if applicable

Diagnosis requires input from teachers. Elementary school students require information from 2 teachers and Middle and High School students require information from 4 teachers.

At least HALF of the teachers should teach core subjects (math, english, history, science)

Please ask EACH teacher to submit the following:

  1. Teacher Vanderbilt Assessments 
  2. Teacher Conners Assessments 
  3. Teacher Narratives - Please have each teacher  email or fax us a paragraph describing  peer relations, social issues, thoughts as to why student is not meeting academic potential. this can be faxed to 703-802-6307 or emailed to [email protected] by the teacher at their convenience. 

Your childs ADHD Consultatuve appointment can only be scheduled AFTER we have the completed packet in our office.

Your first appointment will ussually only require the parents to be present. Please try not to bring siblings along in order to focus as efficiently as possible. Keep in mind the first 10-20 minutes of your appointmenent is for the provider to review documentation.

Contact Us

Our Location

13880 Braddock Road Suite 201 Centreville, VA 20121

Hours of Operation

*Our phones are only open 8AM to 5PM M-F and Saturday 8:30-10. Below are the times that patients are scheduled. We close for lunch 12:45 to 1:15 pm

UNION MILL PEDIATRICS

Monday:

8:00 am-5:00 pm

Tuesday:

8:00 am-5:00 pm

Wednesday:

8:00 am-5:00 pm

Thursday:

8:00 am-5:00 pm

Friday:

8:00 am-5:00 pm

Saturday:

8:30 am-10:00 am

Sunday:

Closed