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.
Drawing and Diagrams

Drawing and Diagrams

Allow your patients to draw on an image or diagram in your form to mark areas of pain or parts of the body that may need treatment.

Sync HIPAA Compliant Form Submissions to Google Drive

Sync Submissions to Google Drive

When you receive a patient form submission, automatically send the submission directly to your Google Drive folder.

HIPAA Compliant Form Kiosk

Kiosk Form Page

Configure a HIPAA compliant form kiosk page to display new patient registration forms, consent forms, and more.

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.

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FormDr gives your practice everything needed to easily send and receive HIPAA compliant forms online. 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