ADHD Screening Questionnaire Adults - The Online Therapy Clinic - Experts in Adult, Children and Parents Psychotherapists

ADHD Screening Questionnaire for Adults

Please fill in the following information.

This section may be duplicated from your initial enquiry, however we need to ensure this information is gathered in order to proceed. These questions are designed for person themselves to fill out, please bare this in mind with the phrasing of the questions.

Full Name:(Required)

Date of Birth:(Required)

Full Address:(Required)

GP Details:(Required)

NHS Number (if known):

Clinician Name(Required)

Primary Contact Details:

Please enter the name of your primary contact, and their details within the next answers. Your primary contact may be yourself.

Please provide information of "other medical conditions:

Please tell us which Professional type was/is involved

Technology Related Exclusion Criteria

This section is to see whether you are subject to any exclusion criteria related to online sessions. NOTE: this is only applicable to online sessions, not Face-to-Face.

General Exclusion Criteria

Clinical Risk Questions

Below are some questions around clinical risk that we are required to collect