Adult ADHD Self Report Checklist

Send this Attention Deficit Hyperactivity Disorder (ADHD) evaluation and symptom checklist to adults before their in-person visit. The online form template uses a 5-point scale for patients to rate how often they notice certain behaviors, from never to very often. Easily collect all of the ADHD information you need to save time when you meet.
Adult ADHD Self-Report Scale

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

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

This template can be easily personalized using the secure form builder.

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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 medical professionals document the symptoms that adults are experiencing and helps guide the treatment team as 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.

Discover More Form Features

Setup secure online forms. Streamline your process of collecting information.
HIPAA Compliant Tablet Forms

Forms on iPads or Tablets

Give customers, clients, or patients the option to sign and complete online forms with an iPad or tablet. Online forms work on all tablets, regardless of operating system.

HIPAA Compliant Electronic Signatures

Electronic Signatures

Easily collect electronic signatures from customers, clients, and patients. Anyone can digitally sign from their phone, tablet, or computer.

HIPAA Compliant File Upload

File Attachment Upload

With file upload fields, your customers, clients, or patients can easily upload documents, pictures, and other items with their online form.

Mobile Friendly Forms

Mobile-Friendly Forms

Build fully-responsive online forms that allow your customers, clients, and patients to sign and submit on any device, anywhere, at any time.

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FormDr gives you everything you need to easily send and receive Secure GPDR compliant forms and documents. We help businesses and practices that:

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