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Down and complete our On-Line form.
OR
If
you are having difficulty uploading your information or photo
or you feel more comfortable faxing the information:
 Click
Here
for the PDF
Subscription Form
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Looking
for more ADD referrals? Be a part of the ADD Consults Team
by joining
our Worldwide Directory of ADD Professionals.
1 year subscriptions are available
at three different listing levels. All listings are searchable by category,
state, and country.
Feel free to browse the Directory before you subscribe. To Join
Now, simply complete the form below. We look forward
to having you as part of the ADD Consults referral network!
* Indicates required fields
Step 1: Choose a Subscription Level
Professional PLUS Listing - $
60.00
US/
1 Year
Stand out from the crowd! Complete listing includes your contact information
with an active link to your e-mail address and Web site, a description
of your services, associations and memberships, and other details
about your practice, PLUS your photograph or logo.
Professional Listing - $
36.00 US/
1 Year
Includes your complete contact information with an active link to
your e-mail address and Web site, a description of your services,
associations and memberships, and other details about your practice.
Professional Basic Listing - $
12.00 US/
1 Year
Includes your name and credentials, your geographic location,
telephone and fax number, and an active link to your e-mail address. |
Step 2: Standard Listing Information and billing Information
Billing Info:
To complete your request for a professional listing, please complete
your payment information below. ADD Consults accepts payment by
MasterCard, Visa, Discover, or American Express. If you wish to
make arrangements to pay by check, please contact
Terry.
All information will remain confidential. For more information, please
see our Privacy
Policy.
Your card will be billed for the professional listing fee in the
amount listed in your selection above in US funds. Once your credit card has been approved,
you'll receive an e-mail notification.
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Select a Category:
Note: If you wish to join as an ADD Coach, please click here.
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| *First Name:
Last Name:
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*Title/Credentials:
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*E-Mail Address:
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*Phone:
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Fax:
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*Address:
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*City:
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*State:
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*Country:
USA |
*Zip:
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International Professionals:
If your office is outside
the United States, please check the box to the right. |
Outside of the United States |
Important:
In an effort to reduce credit card fraud and to protect the
security of your account, the address entered above must
match the address on your credit card billing statement. If
your address does not match exactly, your card will be declined.
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How did you hear about ADD Consults?
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Step 3:
Professional PLUS Listing Information
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| Web Site URL: |
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| Practice Type: |
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| Associations: |
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| Memberships: |
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| Age
Groups: |
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| Modality: |
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| Languages: |
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Payment Options:
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| Office Hours: |
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Please Describe Your Services:
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Upload your image:
We only accept JPEG,
JPG, JPE, GIF and PNG image files
If you need help, email Terry at directory@addconsults.com
Once
you have selected your photo, it will automatically
be uploaded to our server.
This could take 20 seconds to a few minutes, depending
on the size of your photo and your connection speed.
If
your photo does not appear or you're using Netscape
7
CLICK
HERE to review your Photo
Once the photo has
been received, this page will reload with it so you
can review the photo. You can then change it or click
the Continue Order Button. |
Please proofread your information
carefully, then proceed to our secure server to submit
your payment. Once your listing has been approved,
it will be visible in the ADHD Worldwide Directory
immediately.
Netscape 7 users must select remember my field data
if asked or your order will not be processed
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DO NOT PRESS YOUR BROWSERS
BACK BUTTON UNLESS ASKED TO.
DOING SO MAY CAUSE A SECOND DEBIT TO YOU CREDIT CARD.
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