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ADHD QUESTIONNAIRE

ADHD

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.

ADHD Questionnaire

First Name

Last Name

Email

Do you or your child:

have difficulty following directions?

Never

Rarely

Sometimes

Often

Very Often

make careless mistakes?

Never

Rarely

Sometimes

Often

Very Often

forget to turn in work projects or homework assignments?

Never

Rarely

Sometimes

Often

Very Often

have trouble listening or responding when spoken to directly?

Never

Rarely

Sometimes

Often

Very Often

have difficulty following rules?

Never

Rarely

Sometimes

Often

Very Often

have difficulty with tasks requiring sustained concentration?

Never

Rarely

Sometimes

Often

Very Often

have difficulty awaiting your turn?

Never

Rarely

Sometimes

Often

Very Often

loose or forget items needed for work or school?

Never

Rarely

Sometimes

Often

Very Often

have trouble being careful and neat while writing or drawing?

Never

Rarely

Sometimes

Often

Very Often

have difficulty sticking with tasks long enough to complete them?

Never

Rarely

Sometimes

Often

Very Often

become less attentive as the day progresses?

Never

Rarely

Sometimes

Often

Very Often

have difficulty settling down at beginning of school or work day?

Never

Rarely

Sometimes

Often

Very Often

get distracted easily or daydream?

Never

Rarely

Sometimes

Often

Very Often

need repeated reminders to complete steps of the morning routine?

Never

Rarely

Sometimes

Often

Very Often

have difficulty completing test, tasks or activities in the given time?

Never

Rarely

Sometimes

Often

Very Often

have difficulty switching from one task or activity to another?

Never

Rarely

Sometimes

Often

Very Often

interrupt others?

Never

Rarely

Sometimes

Often

Very Often

difficulty sitting still or always being on the go?

Never

Rarely

Sometimes

Often

Very Often

difficulty following through with projects or assignments?

Never

Rarely

Sometimes

Often

Very Often

talk excessively?

Never

Rarely

Sometimes

Often

Very Often

Thank you for contacting us.
We will get back to you as soon as possible.

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Orange County Psychiatric Associates, in Mission Viejo, works with adolescents, and adults to enable them to live their lives to their fullest.

Top Doctor for 2023

Scott Ispirescu

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ORANGE COAST PSYCHIATRIC ASSOCIATES
30131 TOWN CENTER
SUITE 130
LAGUNA NIGUEL, CALIFORNIA 92677

helpdesk@ocpsychiatry.com

Phone: 949.282.0027

Fax: 949.282.0032

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