Once you're in an intake call or initial visit, the answers to a few specific questions tell you whether you're getting a real assessment or a fast-track prescription. Bring this list. Ask politely. Take notes.
About the assessment itself
- "How is the diagnosis made? Walk me through your process."
You're listening for: structured interview, developmental history, rating scales (e.g., ASRS, Conners, BAARS), differential diagnosis consideration. If the answer is "we'll review your form and prescribe in 24 hours," that's not an assessment. - "What scales or structured instruments do you use?"
Reasonable answers include ASRS, Conners CPT-3, BAARS-IV, DIVA-5 (UK), or comparable. "We use our own questionnaire" is less reassuring. - "Will you ask about anxiety, depression, sleep, trauma, and substance use?"
The answer should be yes. If it's no, you're not getting differential evaluation. - "How long is the initial diagnostic visit?"
60–90 minutes is typical for a thorough adult assessment. 15 minutes is too short.
About medication
- "What's your titration approach if I start on a medication?"
You're listening for: low starting dose, weekly or biweekly check-ins, willingness to adjust based on response, awareness of side effects. "We'll start at the standard dose and see you in 3 months" is not a titration plan. - "What if the first medication doesn't work?"
The answer should describe a switching protocol — try a different stimulant class, try a non-stimulant, refer to specialty psychiatry if needed. "We only prescribe X" is a limitation worth knowing. - "How do you handle stimulant prescription refills?"
Schedule II refills require a new prescription each month and can't be phoned in. Understand the practical workflow before you start. - "What happens if I want to stop the medication?"
Look for a thoughtful answer about tapering (especially for non-stimulants) and what indicators would suggest stopping vs. switching.
About cost and ongoing care
- "What does this cost in total — assessment, follow-ups, prescription processing?"
Get the all-in number, not just the headline price. - "Are follow-up visits included or billed separately?"
Some subscriptions include unlimited follow-ups; others bill per visit. Clarify. - "What if I want to cancel?"
Read the cancellation terms. Some services have aggressive auto-renewal. - "Can my care be transferred to my regular GP/PCP after diagnosis?"
Some patients want a one-time diagnosis and then transfer ongoing prescribing to their primary care. Ask whether this is supported.
About differential and limits
- "What would make you decide ADHD isn't the right diagnosis?"
A good clinician should be able to articulate this — significant trauma history, primary anxiety/depression, untreated sleep disorder, etc. If they can't think of any, they're confirmation-biased. - "What other conditions do you commonly see in patients who come in thinking they have ADHD?"
Reasonable answers: anxiety, depression, sleep disorders, autism, trauma, hormonal/thyroid issues. Lists like that signal a clinician who actually does differential thinking. - "Are there situations where you would refer me to a specialist instead of treating in this service?"
Reasonable answers: complex comorbidities, treatment-resistant cases, specific neurological issues. Services that "treat everything" raise eyebrows.
If you're paying with insurance
- "Are you in-network with [my plan]?" Verify with the actual service, not just the insurance directory.
- "What's my likely out-of-pocket?" Ask in writing.
- "Do you require prior authorization?" Some plans require this for specific medications or for psychological testing.
- "Will you submit superbills if you're out-of-network?" If cash-pay, superbills allow you to seek reimbursement from your insurance separately.
If a service won't answer these questions or the answers don't match what's on their website, that's information.