ADHD Pre-Assessment

Take the First Step Towards Clarity

Full Name *

Email *

Phone *

Date of birth *

Do you often have difficulty paying attention to details or make careless mistakes in work or other activities? *

Yes

Do you often have trouble sustaining attention in tasks or play activities? *

Yes

Do you often seem not to listen when spoken to directly? *

Yes

Do you often fail to follow through on instructions and fail to finish work tasks? *

Yes

Do you often have difficulty organising tasks and activities? *

Yes

Do you often avoid, dislike, or are reluctant to engage in tasks that require sustained mental effort? *

Yes

Do you often lose things necessary for tasks or activities? *

Yes

Are you easily distracted by external stimuli? *

Yes

Do you often forget daily activities? *

Yes

Do you often fidget with or tap hands or feet, or squirm in your seat? *

Yes

Do you often leave your seat in situations where remaining seated is expected? *

Yes

Do you often feel restless? *

Yes

Do you often have difficulty engaging in leisure activities quietly? *

Yes

Do you often interrupt or intrude on others? *

Yes

Do you often talk excessively? *

Yes