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ADHD Questionnaire

ADHD Questionnaire

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    Before You Begin

    Please read carefully.

    1. This form is best viewed on a desktop or an iPhone. If you have an Android, it is highly suggested you switch to a desktop.
    2. You may return to an earlier card by pressing the "Previous" button on the card.
    3. Do NOT press "Back" on your browser since that will refresh the screen to the first card and delete all your information.
    4. Do not try to scroll forward and skip cards. Incomplete submissions will not be uploaded to your patient chart causing delays in processing.
    5. If you are having trouble completing the form, do NOT close the browser window. Instead call our office at 469-833-3360 for assistance.
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    The ADHD assessment includes a proprietary questionnaire that is supplemental to the general patient intake forms. It is not an online scoring tool, but a comprehensive investigation to evaluate the presence and severity of ADHD symptoms, as well as their effects on different aspects of your life, such as academic and professional performance, social interactions, and daily activities. Providers use your answers to carefully consider medical, psychiatric, and psychological factors that could be potentially contributing to and influencing the presentation of symptoms and to help distinguish ADHD from other conditions with similar symptoms. Patients are also offered in-depth education on the neurophysiology of the condition and sound reasoning on whether to prioritize ADHD or any co-occurring challenges. Conducting a comprehensive analysis is essential to ensure that we accurately diagnose and recommend the most suitable treatment and interventions. Not all patients will be candidates for stimulants based on medical and psychiatric comorbidities.

    The out-of-pocket cost for new diagnostic ADHD diagnostic assessment is $300.00. The assessment fee is non-refundable and must be paid before proceeding to the assessment. Your consultation is still subject to any copay or deductible outlined in your insurance coverage or the cash fee schedule for private pay patients. Insurance companies do not cover private comprehensive ADD/ADHD assessment and reporting services. 

    For patients who have already undergone a neuropsychological assessment and/or have documentation of prior diagnosis and treatment of ADHD with stimulants for at least one year, your assessment fee can be waived if you provide past medical records. Without documentation, you will need to undergo a new diagnostic evaluation.

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        The following questionnaire adapts to your answers and triggers clarifying questions when needed. The form takes approximately 20 minutes to complete so please allow enough time to complete the form once you start. The questions are best view on a desktop but are designed to be mobile-friendly. Please submit at your earliest convenience but no later than 5pm the day before your consultation to allow us time to review in advance and best prepare for your visit. We look forward to getting to know you!

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        Distractibility
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        Inattention
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        (i.e.creativity, spontaneity, humility, courage)
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      • 45

        You have declined the ADHD diagnostic assessment. You are still scheduled for your upcoming visit (which will exclude consideration of ADHD). If you reconsider completing the form at a later date, please let your provider know. 

        Thank you.

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      ADHD Supplemental Questionnaire
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