The ACFB Fund

ACFB / Nelson Clinic Consent Form

A Change for Better (The ACFB Fund) has partnered with the Nelson Clinic to streamline the process of accessing medication services for adults newly diagnosed with Attention-Deficit/Hyperactivity Disorder. Clients who are diagnosed with ADHD through A Change for Better (The ACFB Fund) can get a direct referral for a medication consultation with the Nelson Clinic.

To streamline this process, A Change for Better collects consent from clients requesting an ADHD evaluation to forward their test results to the Nelson Clinic if the client is considering medication for their symptoms.

The fees you have paid for this assessment cover the evaluation through A Change for Better (The ACFB Fund) only. They do not cover serices through the Nelson Clinic. Should you choose to pursue medication services through the Nelson Clinic, you are responsible for all fees associated with those services. However, you will not have to receive a new ADHD assessment to receive medication management services with Nelson Clinic.

Information about the Nelson Clinic’s ADHD treatment services can be found here:

https://nelsonclinic.nz/services/adhd

By completing the form below, you acknowledge that you have read and agree to this document, and authorise A Change for Better (The ACFB Fund) and the Nelson Clinic to communicate about your treatment. The Nelson Clinic will receive a copy of your assessment report.

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Name of Applicant
Name of Parent/Guardian Completing on Behalf, if applicable
Date of Birth
By selecting "Yes" below, you acknowledge that you have read and agree to this document, and authorise A Change for Better (The ACFB Fund) and the Nelson Clinic to communicate about your treatment. The Nelson Clinic will receive a copy of your assessment report.
By selecting yes, I am also confirming I am the person listed above or have the authority to act on their behalf.

By selecting no, I am opting out of this agreement. I understand I can opt in at a later date should I change my mind.
Clear Signature
Date Signed

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.

Thank You

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Thank you for submitting your application to The ACFB Fund.

Our team will review your application and be in touch with you soon.

To access some of our free resources then please take a look at our Wellness Info