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ADHD Questionnaire

You have contacted the practice looking to arrange an assessment for possible ADHD.

This assessment is carried out by the community mental health team (CMHT).

At present the waiting time for an ADHD assessment is about 12 months.

ADHD is neurodevelopmental condition that can impact your behaviour and the way you experience the world around you.

If you have ADHD your brain might work differently to other people. It means that the way your brain controls your concentration, activity levels and impulses is a bit different – this is a form of neurodiversity.

For example, you might act without thinking about the consequences or be very easily distracted.

Symptoms tend to start very early in life, before the age of six. Lots of people will get an ADHD diagnosis at this age, but you can be diagnosed at any stage in your life and you might not realise you have ADHD until you’re much older.

Symptoms for ADHD can be different for everyone and can depend on your age, sex, gender identity and whether you have any other neurodevelopmental conditions.

ADHD can run in families, but the cause is mostly unknown.

At present there is a huge demand for ADHD testing and often referral are rejected due to lack of information.

To help the CMHT assess your referral please complete the following form with as much information as possible. If you require a paper copy, please contact our reception team.

It would be helpful if you give specific examples of how you may be hyperactive, impulsive or inattentive and particularly explain with examples how this has affected you throughout your whole life.

Personal Details
First Name
Last Name
email
Date of birth
Phone Number
ADHD Self Report Scale (ASRS-v1.1)

Please answer the questions below, rating yourself on each of the criteria shown using the scale from never to very often. As you answer each question, select the answer that best describes how you have felt and conducted yourself over the past 6 months.

Part A

1. How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?
2. How often do you have difficulty getting things in order when you have to do a task that requires organisation?

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Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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Kessington Medical Centre

85 Milngavie Road, Bearsden, Glasgow, G61 2DN

  • 0141 212 0700
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Advertise Your
Business Here
Attendance
Allowance -
help applying
Local Services
Financial help if 66yrs+ and have medical condition
Will
Writing
Optician
Advertise Your
Business Here
Attendance
Allowance -
help applying
Local Services
Financial help if 66yrs+ and have medical condition
Will
Writing
Optician
Advertise Your
Business Here
Attendance
Allowance -
help applying