SCHEDULE AN APPOINTMENT

A SMALL STEP TO CHANGING YOUR FUTURE

Thank you for taking the time to complete this quick questionnaire. Your responses are very important in helping us guide you through your first steps to taking control of your ADHD.

Do you or your child:

Never
Rarely
Sometimes
Often
Very Often
have difficulty following directions?
make careless mistakes?
forget to turn in work projects or homework assignments?
have trouble listening or responding when spoken to directly?
have difficulty following rules?
have difficulty with tasks requiring sustained concentration?
have difficulty awaiting your turn?
loose or forget items needed for work or school?
have trouble being careful and neat while writing or drawing?
have difficulty sticking with tasks long enough to complete them?
become less attentive as the day progresses?
have difficulty settling down at beginning of school or work day?
get distracted easily or daydream?
need repeated reminders to complete steps of the morning routine?
have difficulty completing test, tasks or activities in the given time?
have difficulty switching from one task or activity to another?
interrupt others?
difficulty sitting still or always being on the go?
difficulty following through with projects or assignments?
talk excessively?