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ADHD Assessment Anchor

Contact

the ADHD psychology clinic

Phone: 1300 171 792

Mon - Fri: 9am - 5pm

Email:

admin@adhdpsychologyclinic.com.au

Fax: (03) 9125 8210

Address:

Suite 97, 3 Albert Coates Lane

Melbourne VIC 3000

Adult ADHD Screening Questionnaire

Complete and submit this form if you would like one of our team to score your results and advise whether it is clinically appropriate for you to be assessed for Adult ADHD (i.e. 18 years and over).

Answer the questions based on how you've felt and conducted yourself over the last 6 months.

Qu.1.... How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done? *

Never

Rarely

Sometimes

Often

Very Often

Qu.2.... How often do you have difficulty getting things in order when you have to do a task that requires organisation? *

Never

Rarely

Sometimes

Often

Very Often

Qu.3.... How often do you have problems remembering appointments or obligations? *

Never

Rarely

Sometimes

Often

Very Often

Qu.4.... When you have a task that requires a lot of thought, how often do you avoid or delay getting started? *

Never

Rarely

Sometimes

Often

Very Often

Qu.5.... How often do you fidget or squirm with your hands or feet when you have to sit down for a long time? *

Never

Rarely

Sometimes

Often

Very Often

Qu.6... How often do you feel overly active and compelled to do things, like you were driven by a motor? *

Never

Rarely

Sometimes

Often

Very Often

First Name

Last Name

Phone Number

The outcome of your Screening Questionnaire will be emailed. If you don't receive our response within 2 business days please phone the clinic on 1300 171 792

Thank you for your submission!

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Ph: 1300 171 792

ABN: 36 654 232 014

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