ADHD: Online GP Referrals

PATIENT DETAILS

Patient First Name

Patient Last Name

Email

Telephone

Patient's date of birth

Patient's address

Date of Birth

REFERRER DETAILS

Name of provider (GP or specialist)

Provider Number

Practice Name

Practice Email

Reason for referral

Relevant past medical and psych history

Upload any relevant medical documentation

Has patient previously been diagnosed with ADHD by psychiatrist or paediatrician?

Patient has been diagnosed with ADHD

Yes No

This free ADHD screening test is designed for individuals who believe they might benefit from a more detailed ADHD evaluation.

How often do you have difficulty unwinding and relaxing when you have time to yourself?

Very Often Often Sometimes Rarely Never

When you’re in a conversation, how often do you find yourself finishing the sentence of the people you are talking to before they can finish it themselves?

Very Often Often Sometimes Rarely Never

How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?

Very Often Often Sometimes Rarely Never

How often do you depend on others to keep your life in order and attend to details?

Very Often Often Sometimes Rarely Never

How often do you put things off until the last minute?

Very Often Often Sometimes Rarely Never

How often do you leave your seat in meetings or other situations in which you are expected to remain seated?

Very Often Often Sometimes Rarely Never

SUBMIT YOUR DETAILS TO REVEAL RESULTS

Disclaimer: Please be advised that this online ADHD screening test is designed for informational purposes only and is not intended to diagnose or treat any medical or psychological condition. The results should not be considered as a definitive diagnosis of ADHD or any related disorders. Only a qualified healthcare professional, such as a psychiatrist or psychologist, can provide an accurate diagnosis based on a comprehensive evaluation.