The ACFB Fund

ADHD or Autism Application

Please read this application carefully and respond to all of the required questions (marked with a *)

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Please note:

Our services are fully conducted online. You will need access to a computer or smart phone to full in online questionnaires links and PDFs we send you and also in order to meet online with one of our psychologists.

If you are do not have access to these or have someone who can help you with the forms or accessing the session, then unfortunately, we will not be able to offer you our service.

We provide our service online as it gives us the greatest ability to serve the most people regardless of their location in New Zealand and it allows us to keep our costs low meaning meaning we can offer our services at affordable rates.

What support are you looking for?
Please select carefully. Note that there is a difference in the services you will get when you select Standard, Brief or Urgent (as well as a difference in the cost). Please refer to the information on this link for details.
Please provide the name of the individual who needs the assessment(s)
Gender
Please let us know the gender of the individual who needs the assessment(s)
Please provide the name of the parent, guardian or support worker if this is an application being created on behalf of someone else. This can be left blank if you are submitting this application for yourself.
Location
Ethnicity
If this application is for a child (younger than 18) who is still living at home then please make this the household income.

For adult couples (18 or older) this is your household regular income from any source - salary, wages, WINZ, student allowance etc

For any other single adult (18 or older) this is your regular income from any source - salary, wages, WINZ, student allowance etc
Do you have any history of trauma?
Have you had any of these previous mental health diagnoses or suspected diagnoses? Select any that apply
Do you have any current or past significant medical issues?
Are you currently experiencing thoughts of suicide?
Click or drag files to this area to upload. You can upload up to 5 files.
You can do this as up to 5 images if you need. Please make sure it is your most recent statement. We are using this to validate your regular income

File Types accepted: jpg,gif,pdf,heic,png,webp,jpeg
Click or drag files to this area to upload. You can upload up to 2 files.
You can do this as up to 2 images if you need.

File Types accepted: jpg,gif,pdf,heic,png,webp,jpeg
Click or drag files to this area to upload. You can upload up to 3 files.
You can do this as up to 3 images if you need.
File Types accepted: jpg,gif,pdf,heic,png,webp,jpeg
In submitting this application I understand/agree with the following :

* That my information and application will be viewed within the ACFB Fund Clinical Team to determine my eligibility.
* I have provided documentation of ALL income sources and understand that if I am dishonest about my true income, I may not be accepted into the program.
* In submitting this application I understand and agree to all the terms and conditions of this program, including the no-refund policy should I make a payment.
* I understand that this is NOT a medication management service. If the results of any assessment include a recommendation for medication then ACFB will refer to the Nelson Clinic (who will accept any diagnosis provided by ACFB). There will be a cost for any services then provided by the Nelson Clinic - they can advise on what those costs will be.
* I also understand that The ACFB Fund will keep confidential records on the statistics around how my application/funding is used and may reach out for this purpose.
* I confirm that all details submitted in this application are true and accurate, to the best of my knowledge.

If you are unsure about any of these, please email info@acfbfund.org.nz with your questions before submitting this application
Agreement

If you are looking for autism related funding through NASC/ Whaikaha then this is not the assessment for you at this time.

Whaikaha have changed their minds after years of accepting telehealth diagnoses and have said our diagnoses no longer meet their long list of strict criteria. We will be providing support to those who already received a diagnosis with us but are not sure about going forward if we will continue the higher requirements now set forth by Whaikaha. 

In the meantime, we are advocating to anyone and everyone who might be able to help us and would love your support as well. Please make a complaint. You can find more information on the Whaikaha website here.

The ACFB Fund is not a crisis counselling centre, and we cannot provide emergency services for active or prospective clients.

If you’re in a life-threatening situation or experiencing a mental health emergency, this service is not appropriate for you at this time. Instead, use the following helplines to get the support you need:

  • Lifeline New Zealand: 0800 543 354 (call or text)
  • Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO)
  • 1737 – Need to Talk?: Free call or text 1737 to speak with a trained counsellor (available 24/7)
  • Healthline: 0800 611 116 (available 24/7)

These contacts are available for immediate crisis support and can help connect you to further assistance.