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Where are you from? Diagnosis Status Full Name of Parent/Carer referring Address Postcode Phone Number Email Address Relationship to Child/Children Child/Children full Names Child/Children Date of Birth Home Address (if different from above) Postcode (if different from above) How many people are in your family home Presenting Issues Please provide us with a copy of your child or childrens formal diagnosis letter from CAMHS What other services are involved with the family? Which of our services do you or your child/children require? (please see our How We Help page for information about all our groups and services.) DATA PROTECTION - UK GDPR Dundee and Angus ADHD Support Group needs to hold a copy of your personal data so that we can contact you regarding the services we have available for you. your data will be held securely in our database

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