Application Form.

Free ADHD Screeningadmin2025-05-06T13:05:55+00:00

Thank you for your interest in NVOX’s free ADHD diagnostic program. This program offers a detailed online assessment and personalized report, entirely free of charge, for families who may not otherwise be able to afford private evaluations.

We currently offer free assessments on an ongoing basis. If selected, you’ll receive a comprehensive report and a one-on-one consultation with a licensed psychologist in your state. The program is designed for children and teens ages 8 to 18.

This is a very short form – it should only take a few minutes to complete. Please fill it out to apply.

First Name *

Last Name

Email Address *

City *

State/Province *

Phone

Financial Eligibility

This program is intended for families facing financial limitations. Please answer the following:

Does your child qualify for free or reduced-price school meals? *YesNo

Do you currently receive any government assistance (e.g., SNAP, Medicaid)? *YesNo

Would you consider your current financial situation a barrier to accessing ADHD diagnostics privately? *YesNo

About Your Child

Child’s Birthday *

Has your child shown any of the following? (Check all that apply) *(Check all that apply)Trouble concentratingImpulsivityDifficulty following instructionsForgetfulnessRestlessness or hyperactivity

Has a teacher ever expressed concerns about your child’s learning or attention? *YesNo

Can we contact your child’s teacher to complete a short questionnaire? *YesNoMaybe

Has your child ever been evaluated for ADHD or a learning disability? *YesNo

How much do these difficulties impact your child’s academic or social life? *SignificantModerateMinimal

What motivates you to seek an ADHD screening for your child? *

If your child is selected, will you commit to participating in the process and using the results to support them? *YesNoMaybe

Consent *

I understand and agree to participate in this process if selected.

All information will be kept confidential and used only for the purpose of this screening.

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Newark, DE 19702
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