Remote practices differ from each other far more than in-person practices do. Two services with identical websites can be a full clinical team with continuity and a questionnaire attached to a prescription pad. The difference is not visible from the marketing, and it is entirely visible from a dozen direct questions.
Ask these before you move anything.
About the clinician
1. Will I see the same clinician each time? Continuity matters most for anything being adjusted over months. Some services rotate by design. That can be fine if the record is good, but you should know which arrangement you are entering.
2. What is their licence and specialty, and are they licensed where I live? Licensing follows the state you are physically in. If you travel or split time between two places, say so now.
3. How long is a follow-up appointment, and how often? "As needed" is not a schedule. For anything titrated, a service that cannot see you within a few weeks of a change is not set up for adjustment.
About prescribing
4. Can you prescribe the specific medication I take, to me, in my state, today? Be specific and insist on a yes or no. Rules for prescribing controlled medications remotely — which includes most ADHD stimulants — have changed repeatedly since 2020 and will change again. A service that answers this with reassurance rather than an answer is a service that will disappoint you at the pharmacy.
5. What happens with refills, and who handles prior authorisation? The administrative work around a prescription is real work, and a service that leaves it to you will cost you days each year.
6. Do you prescribe to my pharmacy, or only your own? Some services require a mail-order pharmacy. Ask what that means for a dose change mid-month.
About between visits
7. If I message on a Tuesday, who reads it and when? The most revealing question on the list. Answers range from "a nurse, same day" to "someone will get back to you", and the second one means nobody has decided.
8. What happens if something gets worse on a weekend? Every service has an answer. Get it before you need it.
9. Is there a care management programme, and will I be billed for it? If a nurse is going to call you monthly, that is usually a billed programme. Fine — but ask what it costs.
About records and exits
10. Can my existing clinician see what happens here, and can you see their records? If you are keeping a local clinician, this determines whether you have one care team or two unconnected ones. Ask specifically whether notes are shared, or only available on request.
11. If I leave, what happens to my record, and how do I get a copy? You are entitled to your records. The question is how hard it is in practice — a portal export, a written request, a fee, a delay. Ask before you need it, because the moment you need it is the moment you are leaving.
12. What does this cost per month, all in? Membership, visits, labs, assessments, programme copays. Ask for it in writing.
Two warning signs
A diagnosis promised from a questionnaire. Screening tools decide who needs a closer look. They are deliberately over-inclusive and they are not assessments. A service that treats a fifteen-question form as a diagnosis is cutting the step that matters most.
No path to the things it cannot do. A good remote service concludes, sometimes, that you need an examination, imaging, formal testing, or an in-person specialist — and tells you how to get there. One that never reaches that conclusion has stopped being cautious.
Before you switch: the handover
Do these three things while you still have both:
- Get your records first. Notes, medication history, any test results. Do not rely on a transfer request completing.
- Overlap the prescription. Do not let a refill fall in the gap between practices. Line up the first remote appointment before the current supply runs out.
- Write your own history down. What you have tried, at what dose, for how long, and why you stopped. Nobody else will have this in one place, and it is the single most useful document you can bring to a new clinician.