Skip to content
Facebook Instagram Linkedin
Book a Consultation
Online CBT and EMDR therapist
Facebook Instagram Linkedin Spotify
Book a Consultation
  • Therapists
  • Therapy
    • ERP
      • ERP for OCD
      • ERP for Children & Young People OCD
    • EMDR
      • EMDR for Trauma and PTSD
      • EMDR for Attachment
      • EMDR for Performance
    • CBT
      • CBT Children and Young People
      • CBT for Pregnancy
      • CBT for Sleep – CBT-i
      • CBT for Performance
      • CBT for Anxiety
      • Trauma-Focused CBT
    • ADHD Assessments
      • ADHD Assessment for Children and Young People
      • Adult ADHD Assessment
  • Therapist Corner
    • Supervision
    • Resources
    • Workshops
  • Corporate
  • Blog
  • Contact
  • Fees
  • Therapists
  • Therapy
    • ERP
      • ERP for OCD
      • ERP for Children & Young People OCD
    • EMDR
      • EMDR for Trauma and PTSD
      • EMDR for Attachment
      • EMDR for Performance
    • CBT
      • CBT Children and Young People
      • CBT for Pregnancy
      • CBT for Sleep – CBT-i
      • CBT for Performance
      • CBT for Anxiety
      • Trauma-Focused CBT
    • ADHD Assessments
      • ADHD Assessment for Children and Young People
      • Adult ADHD Assessment
  • Therapist Corner
    • Supervision
    • Resources
    • Workshops
  • Corporate
  • Blog
  • Contact
  • Fees

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.

MM slash DD slash YYYY

Primary Contact Details:

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

Do you have any of the following?:(Required)

Please provide information of "other medical conditions:

Are any other Professionals Involved?:(Required)

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.

Do you have access to a laptop or computer?(Required)
Please note: Devices must have a webcam, a tablet, 10 inches or larger in size, may be used, however must be propped up and be able to be used hands-free. Mobile phones or other handheld devices are not permitted.
Do you have internet access in a private place?(Required)
Are you willing to to conduct the assessment with your camera/webcam turned on for the full duration of the assessment?(Required)

General Exclusion Criteria

Are you currently serving a prison sentence or are on temporary release?(Required)
Are serving in the Armed Forces?(Required)
Are you currently undergoing a safeguarding investigation?(Required)

Clinical Risk Questions

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

Have you self-harmed to a degree that has required treatment by a healthcare professional(Required)
Have you made an attempt to end your life?(Required)
Have you expressed thoughts about ending your life or that you would be better off dead?(Required)
Have you engaged in risky behaviour? e.g. Use of drink or drugs, theft, or other criminal behaviour.(Required)
Have you harmed another person to the extent that that person has required treatment by a healthcare professional?(Required)
Consent(Required)
Agree(Required)
Terms(Required)
Online CBT and EMDR therapist
[email protected]

Quick link

  • Our approach
  • Therapy process
  • Therapy Cost
  • Terms & Conditions
  • Privacy Policy

Recent Posts

  • Planning for Employee Mental Health: 3 Essentials Every HR Leader Should Know
  • 3 Basic Things to Do for Better Sleep
  • 5 Myths of ADHD and How an Assessment Can Help

© 2025 The Online Therapy Clinic UK Ltd.

Important Notice About Cookies
This website uses cookies to improve your experience. We'll assume you're ok with this, but you can opt-out if you wish. Cookie SettingsAccept
Manage consent

Privacy Overview

This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may affect your browsing experience.
Necessary
Always Enabled
Necessary cookies are absolutely essential for the website to function properly. These cookies ensure basic functionalities and security features of the website, anonymously.
CookieDurationDescription
cookielawinfo-checkbox-analytics11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checkbox-functional11 monthsThe cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checkbox-necessary11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-others11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-performance11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy11 monthsThe cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.
Functional
Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features.
Performance
Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors.
Analytics
Analytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc.
Advertisement
Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. These cookies track visitors across websites and collect information to provide customized ads.
Others
Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet.
SAVE & ACCEPT
Powered by CookieYes Logo