Adult ADHD Background Information

 

Questionnaire

Please fill out the following form to help us understand your condition.

Were you born
What was your behaviour like as a baby/toddler? Tick the descriptions which apply.

Thanks for submitting!

Adult ADHD Background Information

 

Questionnaire

Please fill out the following form to help us understand your condition.

Were you born
What was your behaviour like as a baby/toddler? Tick the descriptions which apply.

Thanks for submitting!

Adult ADHD Background Information

(Form 1)

Please fill out the following form to help us understand your condition.

Have you been asked by us to complete this form?
Were you born
What was your behaviour like as a young child? Tick any that apply
Did you attend nursery?
Were you ever suspended or expelled?
Did you receive any further education at college or university?
Do you have any particular difficulties holding down jobs?
Do you have any children
Have you passed your driving test?
Have you ever been in trouble with the police?
Do you have any history of heart disease?
Do you smoke?
Do you drink alcohol
Have you ever tried any illegal drugs?
Cannabis
Amphetamines (speed)
Ecstacy (pills, E's)
Cocaine (coke)
Crack cocaine
Heroin smoked
Heroin injected
LSD/Acid
Magic mushrooms
Ketamine