Adult ADHD Self Report Checklist

Adults who need to be evaluated for Attention Deficit Hyperactivity Disorder (ADHD) can now easily complete this self-reported symptom checklist before their in-person visit. The form uses a 5-point scale for patients to rate how often they notice certain behaviors, from never to very often.
Adult ADHD Self-Report Scale

Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist

Give your patients the freedom to complete adult ADHD self-report checklists with any device, anywhere. Streamline the way you collect important self—assessment information by setting up your form online.

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What is the Adult ADHD Checklist Form Template?

Many adults suffer from ADHD, which can affect relationships, jobs, and success in many areas of life. This standardized self-assessment form helps adults document the symptoms they are experiencing and helps guide the treatment team as the evaluation continues.  

It is never too late to seek a diagnosis and treatment for ADHD and any other mental health condition that my occur with it. Effective treatment can make day-to-day life easier for many adults and their families.

The liability falls on you to handle patient data in a compliant way. Patient privacy is a serious topic, legislation from the Health Insurance Portability and Accountability Act to the Patient Protection and Affordable Care Act place heavy fines on medical professionals who mistreat patient information.

A medical release form does not empower your staff to share patient information with just anyone. Depending on what is included in the form, the document may release medical information to the patient’s family, other doctors, insurance providers, attorneys, or anyone who may make healthcare decisions on behalf of the patient.

Discover More Form Features

Setup HIPAA compliant online forms. Streamline your process of collecting information from patients.
Conditional Logic

Conditional Logic Forms

Only show information that is relevant to the patient with conditional logic forms. Make it simple for your patients to complete your forms and improve the accuracy of the data you receive with conditional logic.

Automated Bulk Export

SFTP Automated Bulk Export

Generate a bulk export of patient submissions that will be saved as a CSV Excel file. Select your frequency, time of day to export, and which forms you would like to export submissions from.

Prefilled HIPAA Compliant Forms

Prefilled Forms

Send a prefilled contracts, agreements, and forms to have patients securely sign forms customized for them. Create financial contracts with pricing specific to the patient.

HIPAA Compliant File Upload

File Attachment Upload

With file upload fields, your patients can upload their prescriptions, x-rays, medical records, insurance card photos and more with their form submission.

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    Woodlands Dermatology
    Angela H.
  • Patients can fill out the forms at their leisure, and don’t have to print anything. We’re collecting more completed forms than ever, and patients love not having to do anything when they come to the office for the first time.

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  • Sending a PDF was too time consuming for the patients to do, and it required the additional steps of printing and scanning it into our own systems. FormDr made it easier to get patients to complete the forms by email, and it’s a more secure way to provide info than simply emailing back a completed PDF.

    Reload Therapy
    Angie I.
  • Before FormDr, the most common struggle were our patients taking a long time to complete forms in our office. Now patients are able to be seen faster when forms are completed prior to visit. Very easy service to create forms online!

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    Courtney M.
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  • Before, clients weren’t signing our forms before the appointment. FormDr has allowed us to share our documents for client review and signatures. I really appreciate the support, it has been super helpful simplifying our forms!

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FormDr gives your practice everything needed to easily send and receive HIPAA compliant online forms. We help practices who:

  • Are having patients fill out paper forms during the appointment
  • Are emailing patients a PDF or Word Doc to print out, fill out, scan, and send back
  • Are spending time manually printing and scanning paper forms