Dr. Les Tsang is the lead psychiatrist at Circle Medical. He is Board Certified by the American Board of Psychiatry & Neurology (ABPN) and trained at UCLA. He previously served as the Director of Behavioral Medicine at the Napa - Solano Family Medicine Residency program at Kaiser Permanente.
Dr. Tsang employs the latest scientific research combined with over a decade of clinical experience to develop an integrated, technology-enabled approach to ADHD treatment.
Hi! Thanks for having me. ADHD is often misunderstood as being unable to pay attention, but there’s actually a bit more involved. People with ADHD typically *can* focus and pay attention to certain tasks, but have a hard time controlling or regulating their attention span. This will result in being able to focus on tasks that are interesting but having difficulty with starting and staying focused on any task that is routine, repetitive or boring.
I’m glad you asked! The other two components of ADHD that can often be overlooked are activity and impulse control. Activity affects the internal drive for physical movement while I think of impulse control as our internal filter that keeps us from saying or doing the wrong thing at the worst time. When our internal drive for movement is not controlled, it’s really difficult to sit or stand in one place if our drive is telling us to “move”! This is why some people with ADHD have such a hard time waiting in line or sitting through a meeting.
Right. That could be his coping mechanism for that situation.
Without any impulse control, we would share thoughts or ideas without thinking them through or even make decisions or act based on just how we felt in the moment. For example, some people with ADHD will often interrupt and finish the sentences of others.
An adult with ADHD might have difficulty staying on track and completing tasks that need to be done repeatedly on a daily basis and in the same way, which can happen at work or home.
Each person is different and not everyone experiences the same symptoms or the same severity of symptoms. It’s very possible for adults with mild to moderate ADHD symptoms to not recognize their experience as ADHD symptoms.
Circle Medical Patient
ADHD is diagnosed in about 14% of adolescents and about 5% of adults, making it a very common condition.It is estimated that fewer than 20% of adults with ADHD are currently diagnosed and/or being treated.
Ginsberg, Y., Quintero, J., Anand, E., Casillas, M., & Upadhyaya, H. P. (2014). Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. The primary care companion for CNS disorders, 16(3), PCC.13r01600. https://doi.org/10.4088/PCC.13r01600
Most adults with ADHD have mild to moderate symptoms, but these symptoms can still negatively impact their quality of life. ADHD can cause impaired performance at work and difficulty managing personal relationships. Nearly half of adults with ADHD also have anxiety.
15 Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC psychiatry, 17(1), 302. https://doi.org/10.1186/s12888-017-1463-3
It can definitely be intimidating to seek out an official diagnosis for the first time. If you have been researching adult ADHD and believe that you may have mild or moderate symptoms, you can book a video ADHD assessment with a primary care provider through our website. The assessments are done in the privacy of your own home so that you are as comfortable as possible.
If you are not yet ready to book an assessment and would like to do more research, consider watching this video about ADD/ADHD from Dr. Thomas Brown, the Associate Director at the Yale Clinic for Attention and Related Disorders.
Circle uses modern technology to provide you with high quality care that is more convenient and faster than the traditional doctor's office experience.
Comprehensive ADHD assessment over video
Same-day or next-day appointment availability
Diagnosis in 2 appointments
If diagnosed, controlled substance prescriptions are available as an option
Providers specialized in ADHD diagnosis and treatment
Licensed psychiatrist supervisors on staff
As a primary care practice, we can treat you for many other conditions as well, streamlining your medical experience.
Please take a minute to review our FAQ and make sure that you are a good candidate for treatment through our practice before you book your appointment.
Select your state of residence, pick a provider and time, and confirm your insurance coverage for your real-time estimated costs before you finalize your appointment.
Download the app right after you book your appointment, and you’ll receive a few questionnaires to complete prior to your visit.
A few minutes before your scheduled appointment time, you will receive a link in the in-app chat to join the video call. Make sure that you are in an area with a strong cellular connection.
If you are a good candidate for care and an ADHD diagnosis seems likely, your provider will ask you to schedule a follow-up appointment to finalize the diagnosis and discuss your treatment plan. Again, be sure to read through the FAQ to make sure that you are a good candidate for care before booking your appointment.
1-2 hrs after appointment
We provide you with post-30 day launch support and a library of personalised tutorials on how to use your new website so that you are well equipped to take control of the website.
Up to 24 hrs after appointment
Your provider will discuss your treatment plan with you and cover all necessary information on medication. You will discuss a follow-up treatment plan, which may include 2 week follow-ups for a new treatment dosage, or monthly follow-ups for a stable treatment dosage.
Your provider will send any prescriptions to your preferred pharmacy, and we will alert you in the app when your prescription is ready for pick-up. This can take up to 24 hours after your appointment.
Please note that some pharmacies do not have all medications in stock, so a pharmacy re-route may be needed. If this is the case, just let your care team know using the in-app chat.
Replies within 24 hours
You can manage your regular follow-ups by booking and rescheduling your appointments through the app. If you have any questions or need to contact your provider, use our in-app chat to message your care team.
As a fully-licensed primary care practice, we know that treating ADHD is just one piece of making someone healthy. Our 70+ providers offer annual checkups, on demand video appointments, and specialist referrals, and more.Get Care
Our primary care providers are vetted according to strict quality of care protocols determined by UCSF.
Board Certified, Family Medicine, 13 years of experience
Board Certified, Family Medicine, 20 years of experience
Board Certified, Family Medicine, 6 years of experience
Board Certified, Family Medicine, 3 years of experience
Our affiliation with UCSF is more than just a partnership. Our providers must hit specific patient care metrics and consistently deliver the highest possible level of care.Read Full Article
Yes, our providers are able to provide a comprehensive assessment and diagnosis of ADHD/ADD and write the appropriate prescriptions. If you are diagnosed with ADHD/ADD by one of our providers, we are able to provide ongoing treatment in the form of regular check-ins and medication prescriptions.
Please note that booking and paying for a video appointment with one of our providers does not guarantee that you will be given a "confirmed" diagnosis. We encourage you to read through this entire FAQ before booking an appointment, to ensure that our practice is a good fit for you.
Our goal as a primary care practice is to make behavioral healthcare more accessible and integrated with primary care. However, primary care has its limitations and this means that receiving behavioral health treatment through Circle Medical is not for everybody. Please read the following carefully to understand whether Circle Medical may be a good fit for you.
You are a good candidate for receiving a comprehensive ADHD assessment and/or ADHD treatment through Circle Medical if:
- You have never had an ADHD diagnosis before but have always suspected you may have mild to moderate ADHD
- You have had an ADHD diagnosis (with a dosage of less than 60mg/day of a stimulant if on a stimulant treatment plan) as a child but have not taken medication for it in months/years and are noticing the effects on your work and/or personal life
- You have a current ADHD diagnosis (with a dosage of less than 60mg/day of a stimulant if you are on a stimulant treatment plan) and are on a treatment plan with another practice, but would like to explore switching over your treatment to Circle Medical
Circle Medical is a primary care practice, which means that we are not able to treat more complex cases of ADHD/ADD. Circle is not a good fit for you if:
- You require a controlled stimulant dosage of over 60mg/day
- You are regularly taking benzodiazepines for other treatment (such as Klonopin or Xanax)
- You are regularly taking opioids for other treatment
- You have a more complex mental health history that may require psychiatric expertise in order to treat safely (this can include hospitalizations related to mental health and/or having bipolar disorder)
Yes, we write prescriptions for controlled substances. Your provider will determine the appropriate treatment for you.
As a primary care practice, we do have a maximum dose of 60mg/day of most stimulant treatments. Most of our patients require a much smaller dosage for effective treatment. If you have a previous treatment plan of greater than 60mg/day, our practice will not be a good fit for you.
Please note: we also prescribe non-stimulant treatment plans depending on what would be best for each individual case.
To see our list of currently available states, begin booking an appointment.
You must be currently residing in the state of treatment as well as have your primary pharmacy be in that same state in order to be a patient at our practice.
Our ADHD providers are primary care providers (MD's/DO's, NP's, and PA's) who have received specialized training for ADHD intake. They are trained by psychiatrists to ensure a high standard of care, but they are not psychiatrists themselves.
Although it is a commonly accepted practice for many primary care providers to refer their patients to psychiatrists for ADHD diagnosis and treatment, primary care providers are actually also able to diagnose and treat mild to moderate forms of ADHD themselves. If you have mild to moderate ADHD, you can benefit from having your ADHD managed by your primary care provider at Circle while getting access to all of the general practitioner services you would find at your normal doctor's office.
More complex cases will require psychiatrists to diagnose. We encourage you to please read through this entire FAQ to make sure our practice is a good fit for your needs before you book a medical appointment with a provider.
You do not need to book your initial appointment with a doctor. You can book your appointment with any provider that we have available. Our providers are all trained in ADHD diagnosis and treatment. They all work closely together to make sure that we are providing the same excellent standard of care to all patients regardless of which provider you book your appointment with.
We have a 2 appointment process for our ADHD patients to ensure that we will be able to complete a thorough screening and diagnosis process.
The first intake appointment is 30 minutes. Follow-up appointments are 20 minutes each.
$5 - $50 average copay* 1st appointment
$5 - $50 average copay* 2nd appointment
$10 - $100* total, with $5 - $50* monthly follow-ups once stable.
*Note: Your specific copay is dependent on your health insurance coverage. We typically see patients with copays of around $0-$50 per appointment, but this can be higher if you have a high-deductible plan and have not yet hit your deductible this year. To confirm your specific copay estimate, you can click to book an appointment and you will be asked to input your insurance information so that you can receive your cost estimate before confirming the appointment.
Our ability to estimate your costs is dependent on your healthcare insurance's database, so we do not guarantee that the estimate you see is the exact amount you will be billed. For the most accurate estimate of your per-appointment costs, we recommend calling the phone number on the back of your insurance card to ask your insurance plan what your primary care appointment costs are.
$149 1st appointment
$100 2nd appointment
$249 total, with $100 monthly follow-ups once stable.
We contract with most PPO insurance plans. If you are a California Bay Area resident, we also work with a small number of HMO plans.
To verify if we work with your insurance, simply start booking an appointment online. You will be prompted to enter your insurance details and will receive eligibility results instantly as well as an estimate of your appointment cost prior to confirming your appointment.
Some PPO plans that we currently work with are:
Anthem Blue Cross/Blue Shield, Aetna, Blue Shield of California, Cigna, Health Net, Humana, and United Healthcare.
Plans that we cannot work with are:
Unfortunately, we are unable to provide care for patients who have Medi-Cal or Medicaid insurance. This is because we are not licensed Medi-Cal or Medicaid providers, so we are not able to provide care, even if these patients choose to pay cash instead of use their insurance. If you have Medi-Cal or Medicaid, please do not book an appointment with us, as we will be unable to provide care even if you do not enter your insurance information.
If you've been diagnosed with ADHD before and have your diagnosis paperwork available, you can email it to email@example.com. Be sure to use the same email address that you used to sign up when booking your appointment.
Note: This step is optional. After your first visit, we will facilitate getting your medical records from your previous provider.
If you haven't been diagnosed before, we are still able to diagnose and prescribe medication. You don't need to bring anything in particular to your first appointment. We use a 2 appointment process to diagnose ADHD so that our providers can learn about your medical history and symptoms from you on the first call, and then can send you requests for any specific medical history, ADHD tests/questionnaires, etc. before you have your second call.
Circle Medical always puts the health and safety of our patients first. For this reason, we require any patient that is going to receive a controlled substance as part of their treatment plan to either undergo an Annual Wellness Exam with a Circle Medical provider, or to submit the results of one that was conducted by a primary care provider. This enables us to ensure that we are minimizing any potential health risks for our patients.
After you are diagnosed, if you are prescribed medications, we will coordinate sending these prescriptions to your preferred pharmacy.
You may have a 2-week follow-up if you are on a new dosage for treatment. Once your treatment has stabilized, you will have monthly follow-up appointments to maintain treatment.
If you have questions at any time, please feel free to chat with your provider and care team via our secure app.
All of our ADHD appointments have the same initial step: booking a video appointment. We accept patients who have had prior ADHD diagnoses as well as patients who have never been diagnosed with ADHD before. You may book your first video appointment with any of our providers to get started.
Please note that booking and completing an appointment does not guarantee that you will have a confirmed ADHD diagnosis and controlled substance prescription. Your provider has full authority to determine whether or not you are a good candidate for treatment, just like with a traditional doctor's office. Please read this FAQ in its entirety to make sure you are a good candidate for treatment through Circle Medical prior to booking your appointment.
Most patients require two appointments for a complete diagnosis. The first appointment is needed to establish your medical history or any previous diagnoses you have had. After that appointment, your provider will request medical records from previous providers, send you a questionnaire to complete, and book you for a second appointment to complete the diagnosis and discuss your treatment plan.
Your provider will prepare a personalized plan for you after each visit including a diagnosis, recommendation, prescriptions and resources for additional reading.
Have questions about your medical insurance? Notice new symptoms? Your Care Coordinator and doctor are available to talk using secure, HIPAA-compliant chat.
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