ASRS v1.1 Part A

ADHD Screening (ASRS v1.1)

Please answer based on how you have felt and behaved over the past 6 months.

1. Trouble wrapping up the final details of a project once the challenging parts are done

2. Difficulty getting things in order when you have to do a task that requires organization

3. Problems remembering appointments or obligations

4. Avoiding or delaying tasks that require a lot of thought

5. Fidgeting or squirming with your hands or feet when you have to sit down for a long time

6. Feeling overly active and compelled to do things, like you were driven by a motor

Your Information

So we can match this to your chart and follow up.

Full name *Email *PhoneDate of birthAnything you'd like the provider to know?

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A-Nu Health · (312) 796-2646 · info@a-nuhealth.com — These responses are informational and reviewed by your provider. Not a diagnosis. If you are in crisis, call or text 988 or call 911.