Form 028

29 Sep, 2024

M&B Form 028 Document Upload

Use this form to upload updated referrals, assessments or other documents we have requested.

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Max. file size: 30 MB, Max. files: 3.

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M&B Form 012 ADHD Assessment and Treatment Process

Form 012 ADHD Assessment and Treatment Process
Effective 3 March 2025

ADHD Assessment Process

The fee for an ADHD assessment is $1,200 less Medicare rebates of $386.75 making a total out of pocket cost of $813.25.

An ADHD assessment would require at least two meetings with a psychiatrist at the clinic.

We will send you some scales and questionnaires to complete prior to your first appointment and it is expected to be returned at least a week before to your appointment.

The first appointment will take about one hour. If you have any school reports available, please bring them. We encourage reading your school reports in advance and prepare to show teachers comments suggestive of ADHD or other difficulties. We understand that some people have no access to their school reports, and it should not affect your assessment.

Collateral information is required for a diagnosis, and we encourage you to bring a family member or someone who knows you well. We understand that in some cases it might be difficult or not possible. Please let us know and we can try to arrange an alternative way to obtain a collateral information (for example a phone call outside of your meeting with a doctor).

Second appointment – Discussing your diagnosis, management plan, and starting treatment if treatment is indicated.

Urine drug test is a mandatory requirement before starting ADHD medication (stimulants) and can be completed at CliniPath following a referral from our psychiatrist.

If treatment with ADHD medication is indicated but cardio-vascular risk factors are identified, our psychiatrist might need to organise a referral for an ECG (electrocardiogram) or referral to a specialist. Some patients may require further medical input (GP, cardiologist or other specialists) before starting treatment with ADHD medication.

Follow up Appointments:

After stimulant treatment commencement, regular follow-up appointments would be required. The frequency of appointments varies depending on your presentation and complexity. most common schedule is a first review three months after treatment initiation, and then 6 monthly.

Would you like a copy of the process emailed to you?

Yes

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M&B Form 006 Financial Disclosure

Financial Disclosure
Effective 3 March 2025

Mind and Brain is a private medical practice and aims to provide optimal care for each individual patient. Occasionally our practice fees are adjusted to reflect changes in Medicare rebates, practice costs, wages, and new items. From 3 March 2025 Practice Fees are as below.

Description	Fee	Rebate	Gap

ADHD assessment (two appointments)	1,200.00	386.75	813.25
Follow-up appointment with a psychiatrist - standard	250.00	85.00	165.00
Follow-up appointment with a psychiatrist - extended	350.00	130.85	219.15
Follow-up appointment with a psychiatrist - long	600.00	255.90	344.10
Script outside of appointment	60.00	-	60.00
Letter for travel or confirmation of medication	44.00	-	44.00
Letter to third party	Varies	-	Varies

A $250 deposit is required to secure your appointment.

Medicare rebates apply to all consultations with our psychiatrist.

If you intend to claim any refunds through your private health insurer, please check if they provide cover for outpatient psychiatry appointments in advance.

We will send you reminders for your appointments and information how to pay online a week before each appointment.

All follow up appointments must be preauthorized up to 6 days before each appointment and not later than 1 day before your appointment.

If you wish to cancel or move your appointment, we request you provide as much notice as possible and not less than one weeks’ notice for initial appointments. Missing an initial appointment or providing less than one weeks’ notice to cancel or move will incur a $250 fee.

Missing a follow-up appointment or cancelling or moving with less than 24 hours’ notice will incur a $100 fee. If you need to change an appointment, please let us know as soon as possible. We have Telehealth facilities available for follow up appointments if you are Covid positive, have cold and flu symptoms but are still feeling well enough to attend.

Would you like a copy of the financial disclosure emailed to you?

Yes

Name(Required)

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	Yes	No
I would like to receive Appointment Reminders by SMS
I would like to be added to the cancellation list
I would like a copy of my registration details emailed to me after I submit the form

	Yes	No
Resident of Western Australia
My Referral has already been sent to Mind & Brain by my GP

	Yes	No
Have you ever been diagnosed with any major mental condition such as Schizophrenia or Bipolar Affective Disorder?
Have you been diagnosed with personality Disorder?
Have you ever been diagnosed with Anorexia Nervosa and currently experiencing problems maintaining weight?
Have you ever attempted suicide?
Have you been admitted to a psychiatric hospital?
Have you ever received treatment for substance use
Do you currently use any illicit substances, including cannabis prescribed and non-prescribed?
In the last 12 months, have you been taking medication for ADHD?
Do you drink alcohol excessively?
Do you have history of violence or legal problems?
Is anyone from your family attending Mind and Brain Clinic?

Form 028

M&B Form 028 Document Upload

Mind & Brain Clinic

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M&B Form 029 Letter Request

M&B Form 028 Document Upload

M&B Form 027 Script Request

M&B Form 004 - Preauthorization

M&B Form 003 Registration

ADHD Assessment and Treatment Process
Effective 3 March 2025

ADHD Assessment Process

Financial Disclosure
Effective 3 March 2025

Patient Consent to Collect & Disclose Information
Effective 1 August 2024

M&B Form 002 Referral Upload

M&B Form 012 ADHD Assessment and Treatment Process

Form 012 ADHD Assessment and Treatment Process
Effective 3 March 2025

ADHD Assessment Process

M&B Form 006 Financial Disclosure

Financial Disclosure
Effective 3 March 2025

M&B Form 030 Appointment Request

Form 028

M&B Form 028 Document Upload

M&B Form 029 Letter Request

M&B Form 028 Document Upload

M&B Form 027 Script Request

M&B Form 004 - Preauthorization

M&B Form 003 Registration

ADHD Assessment and Treatment ProcessEffective 3 March 2025

ADHD Assessment Process

Financial Disclosure Effective 3 March 2025

Patient Consent to Collect & Disclose InformationEffective 1 August 2024

M&B Form 002 Referral Upload

M&B Form 012 ADHD Assessment and Treatment Process

Form 012 ADHD Assessment and Treatment ProcessEffective 3 March 2025

ADHD Assessment Process

M&B Form 006 Financial Disclosure

Financial Disclosure Effective 3 March 2025

M&B Form 030 Appointment Request

ADHD Assessment and Treatment Process
Effective 3 March 2025

Financial Disclosure
Effective 3 March 2025

Patient Consent to Collect & Disclose Information
Effective 1 August 2024

Form 012 ADHD Assessment and Treatment Process
Effective 3 March 2025

Financial Disclosure
Effective 3 March 2025