Adult ADHD

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Patient Name* This field is required.

First Name

Last Name

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UniqueID* This field is required.

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Email

example@example.com

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This is a 6 question test for adult ADHD. How have you felt and conducted yourself over the past 6 months? Answers to the questions are: "never", "rarely", "sometimes", "often", and "very often"

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How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?* This field is required.

Never

Rarely

Sometimes

Often

Very Often

6

How often do you have difficulty getting things in order when you have to do a task that requires organization?* This field is required.

Never

Rarely

Sometimes

Often

Very Often

7

How often do you have problems remembering appointments or obligations?* This field is required.

Never

Rarely

Sometimes

Often

Very Often

8

When you have a task that requires a lot of thought, how often do you avoid or delay getting started?* This field is required.

Never

Rarely

Sometimes

Often

Very Often

9

How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?* This field is required.

Never

Rarely

Sometimes

Often

Very Often

10

How often do you feel overly active and compelled to do thing, like your were driven by a motor?* This field is required.

Never

Rarely

Sometimes

Often

Very Often

11

Screening Test

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Date

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Scorescores>=4 indicate that symptoms may be consistent with ADHD

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Today's Provider* This field is required.

15

Grading

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ALERT