Patient Registry

First Name*

Last Name*

Date of Birth*

Phone Number*

Enter your email address*

Select all conditions that have been diagnosed by a qualified medical professional (e.g. Medical Doctor, Psychologist, Nurse Practitioner, Mental Health specialist preferred):*

ADHD

Bipolar

Anxiety

Depression

Other

What categories of medication do you currently take for ADHD and related mental health disorders?

Stimulants

Non-Stimulants

Anti-Depressants

None

Other

Please share methods or strategies that have helped you complete tasks and achieve goals. Why they worked?*

Please share methods or strategies that have NOT worked. Why they FAILED?*

Is there anything else you'd like us to know: what frustrates you about ADHD, what you need help with, what are other apps not getting right?

Fill out the form with your personal information and submit to register for our patient registry.

Patient Registry

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