• (New) Transfer your Care - Adult

  • Welcome to your comprehensive online Transfer of Care form. We understand that form filling can be a daunting task, but rest assured, your input is vital for an accurate assessment. By sharing as much information as possible, you allow us to gain a clearer understanding of your unique experiences. Embrace this opportunity to provide valuable insights into your mental health, as it will greatly assist us in tailoring our support to your needs. Thank you for embarking on this essential step towards a better understanding of yourself.

    This form is quite extensive and may take you up to an hour. Please use the 'Save' button below and create a JotForm account with your email. This will prevent the loss of data and allow you to resume editing your form at a later point. Regularly save your progress to avoid losing data.

    Please make sure to contact our team if you have questions or require assistance:  enquiries@adhddirect.co.uk 

    • Click here to enter your contact details 
    • Date of birth*
       - -
      2 digit day, 2 digit month, 4 digit year
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    • Click here to tell us about any previous ADHD/Autism/Mental Health assessments that you may have undertaken.  
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    • PLEASE NOTE: occasionally our JotForm system may encounter errors. If you find yourself unable to upload all the necessary documents due to file size or type restrictions, we kindly request that you send these files to us manually as soon as possible. Please forward the required documents to our dedicated email address, enquiries@adhddirect.co.uk. Our team will promptly process your information and ensure that it is appropriately handled.

    • Reason for Referral

    • Click here to tell us the main reasons you are looking to attend for an neurodevelopmental assessment 

    • Regularly save your progress to avoid losing data.

      Please contact our team if you have questions or require assistance: | enquiries@adhddirect.co.uk 

  • For each question in the table, please choose the answer that best describes your behaviour before commencing treatment.

  • Inattention Symptoms*
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  • Hyperactive Symptoms

  • *
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  • Impulsive Symptoms

  • *
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  • Regularly save your progress to avoid losing data.

    Please contact our team if you have questions or require assistance: | enquiries@adhddirect.co.uk 

  • Further Questions

  • We’d like you to complete a few questions to help us identify any other health conditions that might exist alongside your current difficulties. This information helps us understand whether any additional factors could influence your assessment and overall care.

  • Tell us about any tics you may have noticed:
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  • PHQ-9

  • The PHQ-9 is a brief questionnaire used to assess your mood and identify symptoms of depression. Please answer each question based on how you’ve felt over the past two weeks. Your responses will help us better understand your current wellbeing and guide any support you may need.

  • *
    Rows

  • Score for PHQ-9 0-4 Minimal or none /5-9 Mild/ 10-14 Moderate /15-19 Moderately severe/ 20-27 Severe

  • GAD-7

  • The GAD-7 is a short questionnaire designed to measure symptoms of anxiety. Please answer each question based on how you’ve felt over the past two weeks. Your responses will help us understand your current levels of anxiety and support you in accessing the most appropriate care.

  • *
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  • Score GAD-7 0-4: Minimal anxiety / 5-9: Mild anxiety / 10-14: Moderate anxiety / 15-21: Severe anxiety

  • Some people experience significant trauma in their lives:

  • Are you affected by any past trauma?*
  • If so, do you ever experience flashbacks and distress?*
  • Have you ever experienced the following?
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  • Alcohol and Drug Use

  • The use of alcohol, drugs, or other impulsive behaviours can be more common in people who are neurodivergent, often as a way of coping with stress, boredom, or emotional difficulties.

    We ask about these areas to help us build a full and accurate picture of your background and wellbeing. Please be assured that any information you share is strictly confidential and used only to guide your care and assessment. 

    We’re keen to hear about your alcohol use, smoking history, and any recreational drug use (if applicable). Both past and present use are important to understand, as this information helps us gain a complete picture of your health and wellbeing.

     

    • Alcohol Use:  
    • How often do you have a drink containing alcohol?*
    • How many drinks containing alcohol do you have on a typical day when you are drinking?*
    • How often do you have six or more drinks on one occasion?*
    • How often during the last year have you found that you were not able to stop drinking once you had started?*
    • How often during the last year have you failed to do what was normally expected from you because of drinking?*
    • How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?*
    • How often during the last year have you had a feeling of guilt or remorse after drinking?*
    • How often during the last year have you been unable to remember what happened the night before because you had been drinking?*
    • Have you or someone else been injured as a result of your drinking?*
    • Has a relative, friend, doctor, or other health worker been concerned about your drinking or suggested you cut down?*
    • Drug Use:  
    • *
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    • Caffeine Intake:  
    • Do you drink caffeine or drink high caffeine energy drinks? (more than 5 drinks a day)*
  • Tell us about your relationship with food. Have you experienced any of the following?*
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  • The Adult Autism Spectrum Quotient (AQ-10)

  • The AQ-10 (Autism-Spectrum Quotient-10) is a brief screening questionnaire used to identify traits associated with Autism Spectrum Disorder (ASD) in adults. It includes ten questions about social understanding, communication, and attention to detail. We use the AQ-10 as part of both our ADHD and ASD assessments, as there is often a significant overlap in traits between the two conditions. The results provide helpful insight into your neurodevelopmental profile and guide us in determining whether further autism-focused assessment or support may be appropriate.

  • Below are a list of statements. Please read each statement very carefully and rate how strongly you agree or disagree. Please do not miss any statement out. *
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  • Strengths

    We realise that we have focussed largely on problems and difficulties that you may be having. However, we are also interested to understand your strengths, talents, skills, and accomplishments.

  • Regularly save your progress to avoid losing data.

    Please contact our team if you have questions or require assistance: | enquiries@adhddirect.co.uk | 

  • Medical History Checklist

  • Please clarify if you have history of any of the following conditions:*
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  • Important Information - Measurements

  • As part of the Transfer of Care process, we ask for some basic health measurements. This helps us gain a general understanding of your overall health and wellbeing, including your cardiovascular status (for example, your blood pressure, heart rate, and weight). If medication is being considered as part of your treatment plan, we will need these measurements in order to proceed safely. Please try to have these measurements completed before submitting this form or bring them with you to your appointment. This will help us ensure your care is managed efficiently and safely.

  • Please make sure to answer every row*
    Rows

  • For ADHD Direct patients who need to record their height, weight, and blood pressure, there are a few convenient options available:

    1. Measure at home:
    You may wish to purchase your own equipment online at an affordable price. A digital scale can provide accurate weight readings, and a home blood pressure monitor allows you to track your blood pressure easily and reliably.

    2. Visit a healthcare professional:
    Alternatively, you can have these measurements taken at your GP practice, by a practice nurse, or at an NHS pharmacy. They have the appropriate equipment and expertise to take accurate measurements and can provide guidance to ensure reliable results.

  • Significant Medical Conditions

  • Please clarify if there is any history (past or current) of the following conditions:*
    Rows

  • Medication History

  • Please give the details of your full medication history. If you have not been on any significant medications, please type N/A in each of the three boxes below. *

  • Regularly save your progress to avoid losing data.

    Please contact our team if you have questions or require assistance: | enquiries@adhddirect.co.uk | 

  • Shadowing Consent:

  • At ADHD Direct, we have an ongoing programme of training and supervision for clinicians who wish to specialise in the field of neurodiversity. As part of this, we frequently work with clinicians who are developing their clinical skills.

    In order to gain experience, these clinicians must be supervised or shadowed by a more senior clinician. This means that, in some appointments, there may be two clinicians present—one conducting the assessment and the other observing or assisting under supervision.

    All clinicians, including those in training, are strictly bound by confidentiality rules. You have the right to choose whether you are comfortable with having an additional clinician in the room during your appointment. You can also decide whether you are happy for them to take an active role in your assessment.

    Whatever you decide, we fully respect your wishes, and your choice will never affect the quality of your care or treatment.

  • Do you consent to having a student or clinician shadow your appointment? (This means they will be present in the room, observing your assessment.)*
  • Do you consent to your shadowing a student or clinician participating in your assessment?*

  • Consent to Contact Your GP

  • In order to provide a thorough neurodevelopmental assessment and safe, effective treatment, we request your consent to communicate with your General Practitioner (GP). This may include obtaining a GP summary sheet and, where necessary, additional information about your medical history.

    Following your appointment, we will also share relevant information with your GP typically in the form of a written assessment letter outlining the outcome of your assessment.

    This collaboration is clinically essential to ensure an integrated and informed approach to your care. Engaging with your GP allows for a more complete understanding of your health, supports coordination between healthcare providers, and helps us deliver the safest and most effective treatment plan.

    Please note: we do require this consent in order to proceed with your neurodevelopmental assessment.

  • If you do not consent to ADHD Direct communicating and sharing information with your GP then please get in touch with our admin team as soon as possible to explain why you are unable to provide this consent and we can discuss this matter with you directly: enquiries@adhddirect.co.uk 

  • Transcript Consent

    Heidi AI is a secure speech-to-text tool used during ADHD assessments. It helps your clinician capture important details accurately so we can populate your clinical report. Are you happy for your clinician to use Heidi AI or a similar voice to text transcription tool to transcribe your consultation? It does not keep an audio recording of your voice; it simply converts what is said into written text, which our typists then use to check and complete your report accurately.
  • Do you consent to ADHD Direct using Heidi AI during your assessment*

  • Thank you!

  • We want to extend a big thank you for taking the time and effort to complete these important forms. We know it's not always easy, but your input is incredibly valuable to us.

    Now that you've filled out the forms, simply hit the "Submit" button to take the next step. We appreciate your cooperation and trust in our assessment process.

     

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