Puget Sound Behavioral Medicine

New patients must complete the registration and screening process before scheduling an appointment. Our screening process consists of gathering all pertinent information concerning the patient's academic, work, and social history. Upon receipt of the information, Dr. Theodore Mandelkorn will assess the data. Our office will then contact you and set up an intake appointment.

If you are seeking an evaluation for depression and/or anxiety and not ADHD please contact the office for information about what the intake process will be.

Note: All forms referred to on this page require Adobe Acrobat Reader, preferably version 5.0 or newer. Print the form you need, fill it out, and mail it to us (address is provided on the form).

Patients needing a first evaluation
     1. Children/Teens
     2. Adults
     3. Previously diagnosed patients
     4. Services and fees
     5. Appointment scheduling


  1. CHILDREN (under age 18 or still in high school)

1.1  Parents please complete and provide to our office:

1.2  Provide copies—no originals please:

  • All report cards from kindergarten to present. If you do not have these obtain them from your child's school
  • Reports of any standardized school testing such as the WASL, Metropolitan Achievement Test, or Iowa Test of Basic Skills
  • Reports of any testing done by school psychologists, occupational, language or physical therapists
  • Reports of any previous evaluations by physicians, psychologists or psychiatrists

1.3  Obtain completed Teacher Evaluation Form (66k PDF file) from all current teachers and tutors

1.4  We strongly recommend reading one of the following books before your appointment.

Parents of boys: Daredevils and Daydreamers by Barbara Ingersoll

Parents of girls: Understanding Girls with AD/HD, by Kathleen Nadeau, Ellen Littman, and Patricia Quinn

1.5  Send all completed forms to: Puget Sound Behavioral Medicine, 2731 77th Ave SE, Suite #202, Mercer Island, WA 98040.

1.6  When all materials are received and reviewed you will be contacted to set up appointments.

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2. ADULTS (over age 18 and not in high school)

2.1 Please complete and return to us:

2.2  Copies—no originals—of all report cards from kindergarten through college

2.3  Copies of reports of previous tests or evaluations

2.4  If parents are still living ask them to complete the Child History Form (601k PDF file) based on their recollections of your childhood behavior.

2.5  We strongly recommend reading the book
Driven to Distraction by Edward Hallowell and John Ratey. Women may also want to consider reading either Understanding Women with AD/HD by Kathleen Nadeau and Patricia Quinn or Women with Attention Deficit Disorder by Sari Solden.

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3.1  Please complete and return to us:

  • Registration Form (17k PDF file)
  • Release Form (118k PDF file) for each of the following:
    • current physician
    • current or previous psychiatrist or therapist
    • any other professionals you have consulted
3.2  Provide copies of any previous evaluations.

3.3  Parents of previously diagnosed children or teens need to obtain Teacher Evaluation Form (66k PDF file) from all of their child's teachers and tutors.

After Dr. Mandelkorn reviews the above information, our office will contact you and either set up an initial appointment or ask you to complete our questionnaire for further information. The usual two hour-long appointments may not be necessary for you or your child. We will let you know whether the doctor needs one or two hours for your consultation.

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All services at Puget Sound Behavioral Medicine, P.S. including office visits and phone consultations will be payable at the time of service either by credit card or check. We do not bill insurance companies or accept medical coupons. We provide receipts for patients to submit to their insurance for reimbursement. If office notes are needed for submission by your insurance, a release will need to be signed by the patient or family in order for us to communicate with the insurance company.

Some insurance companies will reimburse for the office charges, but it has been our experience that most insurance carriers either deny coverage of charges or greatly reduce charges for the evaluation and treatment. We feel that it is important for you to be aware of this before undertaking an evaluation. We encourage you to check with your insurance provider in advance if you have questions regarding coverage. For your convenience we have provided the Visit Codes for each type of visit that we schedule. Your insurance carrier should be able to tell you what if anything your insurance benefits will pay for these visits. For a current fee schedule for these visits contact our office.

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The scheduling at this office consists of the following:

5.1  For newly diagnosed child patients:
Two one-hour appointments. Both parents should come if at all possible. It can be helpful to bring a tape recorder and tape to record the information provided.

  • First one hour visit (Visit Code 90801)
    • Review of questionnaire, teacher forms, other professional evaluations and history with patient/family
    • Review of diagnosis, modalities of treatment
  • Second one hour visit (Visit Code 99215)
    • Review of diagnosis and treatment recommendations
    • Discussion of accommodations needed if applicable
    • Explanation of phone consultation
    • Start medication if indicated
  • Follow-up visits (Visit Code 99214)
    • Review of medication benefits and side effects and adjust as needed
    • Evaluate social, family, and academic/workplace progress
  • Nurse phone consultation (Visit Code 99371)
    • Monitor progress and treatment effectiveness between office visits

5.2  For newly diagnosed adult patients: (Visit Code 90801)

  • One one-hour appointment is needed
  • Follow-up and Nurse phone consultations as above

5.3  For previously diagnosed patients who wish to transfer care:

  • After review of information provided, the physician will determine what visits are needed

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© 2005 Puget Sound Behavioral Medicine, PS.
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Information on this site is not intended to be personal medical advice. Please directly consult our clinic or another qualified physician if you need specific medical advice.