Our goal is to make it as easy as possible to assist primary care providers in the treatment of patients with ADD/ADHD. For your convenience, there are two ways you can refer a patient to the Adult Attention Deficit Disorder of Maryland.
- You can download a PDF of the patient referral form and fax it to 410-583-2724, attn: Dawn Daniel.
- You can complete our online patient referral form for electronic submission
Online Patient Referral Form
Please read the confidentiality notice below and then click on the continue button.
Privacy is very important to us. The online patient referral form requires you to supply health and contact information that is needed to complete the referral request and shall be utilized only for the purpose of helping the patient secure an office visit. The information will be transmitted by e-mail and will not be secured by encryption software. You consent to disclose confidential health information to Adult Attention Deficit Disorder of Maryland on behalf of your patient. You also acknowledge the risk of sending the information via e-mail and agree to not hold Adult Attention Deficit Disorder Center of Maryland or any of its affiliates, employees or agents liable for any damages that may incur as a result of the transmittal of the information.