Your Details
Please provide your full name, email address and telephone number so we can send you the results of this screening and discuss the outcome.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Phone Number
*
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I like to do things the same way
*
Never
Some of the time
Most of the time
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I would rather hang out alone rather than go to a party with friends.
*
Never
Some of the time
Most of the time
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I tend to notice small details that others don’t.
*
Never
Some of the time
Most of the time
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When I’m reading a story, I have a hard time imagining what the characters might look like or figuring out the characters’ intentions.
*
Never
Some of the time
Most of the time
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I find myself drawn more strongly to people than to things or solitary activities (including video games).
*
Never
Some of the time
Most of the time
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I enjoy social gatherings and/or find social situations easy.
*
Never
Some of the time
Most of the time
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On many occasions, I’ve been told that what I’ve said is impolite, even though I think it is polite.
*
Never
Some of the time
Most of the time
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I frequently find it hard to keep a conversation going.
*
Never
Some of the time
Most of the time
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I find it difficult to imagine what it would be like to be someone else.
*
Never
Some of the time
Most of the time
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I focus more on the whole picture rather than the small details.
*
Never
Some of the time
Most of the time
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I tend to have very strong interests and get upset if I can’t pursue them.
*
Never
Some of the time
Most of the time
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When someone is talking to me, I find it easy to “read between the lines” (understand their true feelings or intentions).
*
Never
Some of the time
Most of the time
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I find it easy to understand what someone is thinking or feeling just by looking at their face.
*
Never
Some of the time
Most of the time
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I often notice small sounds when others don’t.
*
Never
Some of the time
Most of the time
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Numbers, dates, or strings of information fascinate me.
*
Never
Some of the time
Most of the time
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I can easily recognize patterns in things all the time.
*
Never
Some of the time
Most of the time
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New situations make me anxious and nervous.
*
Never
Some of the time
Most of the time
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I prefer reading books about non-fiction subjects like dinosaurs.
*
Never
Some of the time
Most of the time
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I find it hard to figure out people’s intentions.
*
Never
Some of the time
Most of the time
Calculation
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Do you already have a diagnosis for Autism?
Yes
No
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Are you currently looking to book a professional Autism diagnosis?
Yes
No
Not Sure
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