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Last Name
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Street Address
Street Address Line 2
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Q1. How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?
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Never
Rarely
Sometimes
Often
Very Often
Q2. How often do you have difficulty getting things in order when you have to do a task that requires organisation?
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Never
Rarely
Sometimes
Often
Very Often
Q3. How often do you have problems remembering appointments or obligations?
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Never
Rarely
Sometimes
Often
Very Often
Q4. When you have a task that requires a lot of thought, how often do you avoid or delay getting started?
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Never
Rarely
Sometimes
Often
Very Often
Q5. How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?
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Never
Rarely
Sometimes
Often
Very Often
Q6. How often do you feel overly active and compelled to do things, like you were driven by a motor?
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Never
Rarely
Sometimes
Often
Very Often
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Q7. How often do you make careless mistakes when you have to work on a boring or difficult project?
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Never
Rarely
Sometimes
Often
Very Often
Q8. How often do you have difficulty keeping your attention when you are doing boring or repetitive work?
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Never
Rarely
Sometimes
Often
Very Often
Q9. How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?
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Never
Rarely
Sometimes
Often
Very Often
Q10. How often do you misplace or have difficulty finding things at home or at work?
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Never
Rarely
Sometimes
Often
Very Often
Q11. How often are you distracted by activity or noise around you?
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Never
Rarely
Sometimes
Often
Very Often
Q12. How often do you leave your seat in meetings or other situations in which you are expected to remain seated?
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Never
Rarely
Sometimes
Often
Very Often
Q13. How often do you feel restless or fidgety?
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Please select
Never
Rarely
Sometimes
Often
Very Often
Q14. How often do you have difficulty unwinding and relaxing when you have time to yourself?
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Never
Rarely
Sometimes
Often
Very Often
Q15. How often do you find yourself talking too much when you are in social situations?
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Never
Rarely
Sometimes
Often
Very Often
Q16. When you’re in a conversation, how often do you find yourself finishing the sentences of the people you are talking to, before they can finish them themselves?
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Never
Rarely
Sometimes
Often
Very Often
Q17. How often do you have difficulty waiting your turn in situations when turn taking is required?
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Never
Rarely
Sometimes
Often
Very Often
Q18. How often do you interrupt others when they are busy?
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Never
Rarely
Sometimes
Often
Very Often
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Section B Results
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