• Transfer Your Care: Child Form (12 to 15 years old)

  • Welcome to your child's transfer of care form.

    We understand that filling out forms can feel like a big task, but rest assured, your input, along with your child's, is vital for an accurate assessment.

    Depending on the age of your child, they may be able to answer some of these questions themselves, or you may need to assist them in providing their answers.

    These forms are very important for our clinicians to develop an in-depth understanding of your child's unique experiences. Embrace this opportunity to provide valuable insights into their mental health, allowing us to tailor our support to their specific needs. Thank you for taking this essential step towards a better understanding of ADHD and your child’s needs.

  • ATTENDANCE:

    Children's TYC appointments can be attended by one or both parents, this is entirely the family's choice. There is no requirement for both parents to be present, and the assessment can be completed with just one parent attending.

  • The first step is consent to your child's care.

    • Click here to provide consent.  

    • In order to provide safe and effective care during the transfer of care appointment, we request your consent to communicate with your child's General Practitioner (GP). This may include obtaining a GP summary sheet and, where necessary, additional information about your child's medical history.

      Following the appointment, we will also share relevant information with your child's GP, typically in the form of a written letter outlining the outcome of your appointment. Once completed, we will also send your child's GP a copy of the written report. 

      This collaboration is clinically important to ensure an integrated and informed approach to your ongoing care. Engaging with your child's GP supports coordination between healthcare providers and helps us deliver the most effective care plan for you.

      Please note: we do require this consent in order to proceed with the transfer of care appointment.

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

  • Please upload a photo of your identification

    For child's appointments, we do not require the child's ID. Please instead upload the ID of the parent / guardian who is consenting to treatment.
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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.

  • Regularly save your progress to avoid losing data. 

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

  • Additional Forms

    Please use this space to upload any additional forms that you would like for the clinician to view.
  • Browse Files
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    Choose a file
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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.

  • Regularly save your progress to avoid losing data.

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

  • Reason for Referral

  • 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

    • Click here to provide your child's medical history  
    • Has your child had any hospitalisations?*
    • Has your child suffered from any head injuries?*
    • Has your child undergone any surgeries?*
    • Has your child experienced any fractures?*
    • Has your child been involved in any serious accidents?*
    • Did they experience diminished sleep when they were younger?*
    • Does your child experience any sleep problems currently?*

    • Regularly save your progress to avoid losing data.

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

  • Child Management Techniques

  • Regularly save your progress to avoid losing data.

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

  • Tell us about any tics you may have noticed:

  • Please answer every row:*
    Rows

  • Tell us about your child's childhood development. Did your child have any problems with:

  • Please answer every row*
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  • The PHQ-Adolescence 11 - 17 is a brief questionnaire used to assess your child's mood and identify symptoms of depression. Please answer each question based on how your child has felt over the past two weeks. Your responses will help us better understand your child's current wellbeing and guide any support they may need.

  • How often has your child been bothered by each of the following symptoms during the past two weeks? *
    Rows
  • In the past year has your child felt depressed or sad most days, even if they felt okay sometimes?*
  • If your child is experiencing any of the problems on this form, how difficult have these problems made it for them to do work, take care of things at home or get along with other people?*
  • Has there been a time in the past month when your child had serious thoughts about ending their life?*
  • Has your child ever tried to harm themselves with the intention of ending their life?*

  • Do you currently find your child doing the following?

  • Please answer every row*
    Rows
  • The Spence Children’s Anxiety Scale (Parent Version) is a validated questionnaire that helps us understand whether your child may be experiencing symptoms of anxiety. It asks about common worries, fears, and behaviours that some children experience, and your responses provide valuable insight into how anxiety may be affecting your child’s day-to-day life. This information supports a more comprehensive and accurate understanding of your child’s needs. Please choose the option that best describes your child*
    Rows

  • Some children experience significant trauma in their lives:

  • Has your child been affected by any past trauma?*
  • If so, do they ever experience flashbacks and distress?*

  • Has your child ever described the following:

  • Please answer every row*
    Rows

  • 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 child's background and wellbeing. Please be assured that any information you share is strictly confidential and used only to guide your child's care and assessment.

  • We’re keen to hear about your child's 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:  
    • Does your child drink alcohol? If so, how often?*
    • Drug Use:  
    • 1. Has your child ever used drugs other than those required for medical reasons?*

  • Tell us about your child's relationship with food. Have they experienced any of the following?

  • Please answer every row*
    Rows

  • (AQ-10 12 - 15 years old)

    As part of the assessment, we carry out screening for autistic traits. These traits are common in children with ADHD, and there is also a higher likelihood that some children with ADHD may meet the criteria for Autism Spectrum Disorder (ASD). For this reason, we routinely include autism screening as part of our assessments and appreciate you completing the following questionnaires.
  • Please tick one option per question only: *
    Rows

  • Medical History Checklist

  • Please clarify if your child has a history of any of the following conditions, making sure to answer every row:*
    Rows

  • Measurements

  • Please take the following measurements for your child. We recommend using a digital home blood pressure monitor, as regular blood pressure readings are required as part of ADHD treatment if a diagnosis is confirmed.

    If ADHD is diagnosed and you are considering medication, it is helpful to have these measurements ready when completing this form or available at the appointment. Having this information in advance helps avoid delays and supports timely access to treatment.

  • Please answer every row*
    Rows

  • Alternatively, you may visit your local GP surgery, practice nurse, or NHS pharmacist. These services typically have the appropriate equipment and expertise to accurately measure height, weight, and blood pressure, and can offer professional support to ensure reliable measurements.

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

  • Strengths and Accomplishments

    We realise that we have largely focussed on problems that your child may be having. However, we are also quite interested in understanding your child's 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 

  • Confidential Parental Feedback

  • Please be aware that, during your child's appointment, it may not be possible to speak to you alone, without your child being present. 

    As such, we have provided this box in order for you to discuss any confidential matters that you would not like to speak about in front of your child. 

    Information submitted in the box below will be considered when assessing your child, but will not be mentioned to them in your appointment or in their report. 

    PLEASE NOTE: If there is sensitive information you would like to discuss in-person with your child's clinician, then please bring a SECOND supervising adult to your child's appointment. This way your child can be supervised in the waiting room while you have a private conversation with the clinician. 

  • 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 your child's appointment shadowed by another clinician or student ? (Having an additional clinician in the room, observing the assessment?)*
  • Do you consent to a shadowing clinician or student participating in the appointment?*

  • 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 child's clinical report. Are you happy for your clinician to use Heidi AI or a similar voice-to-text transcription tool to transcribe your child's consultation? It does not keep an audio recording; it simply converts what is said into written text, which our typists then use to check and complete your child's report accurately.

  • Do you consent to ADHD Direct using Heidi AI (or similar) during your child's assessment*

  • Regularly save your progress to avoid losing data.

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

  • 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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