JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Tell us about yourself
Hey there! My name is Ziqun and I am a 2nd year MBA at Harvard Business School and am working on a startup to improve quality of care for employees with ADHD, a project originated from my own struggles in finding proper care and support.
Understanding ADHD manifests differently in different individuals,
I would love to learn your experience with ADHD care through this survey. It will take about 10 minutes. Your input will be very valuable. If you have any questions and/or I can help out in any way, feel free to email me at
zzhou@mba2024.hbs.edu
.
ALL INPUT WILL BE ANONYMOUS.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Age
*
Choose
18-24
25-34
35-44
45-54
55+
Gender
*
Choose
Male
Female
Non-binary
Prefer not to say
What industry do you work in?
*
Consulting
Finance
Law
Entertainment & Media
Technology
Healthcare
Manufacturing
Energy
Retail and Consumer Services
Education
Other:
Job title?
*
Your answer
What state do you live in?
*
Your answer
Which of the following best describes your ADHD diagnosis?
*
Formally diagnosed by a professional
Self-diagnosed based on personal research and experiences
Suspected ADHD, but not yet diagnosed
Not sure
If you've been formally diagnosed by a professional, when was your diagnosis?
*
less than 1 year ago
1-3 years ago
4-6 years ago
6+ years ago
Not sure
Any co-occurring conditions with ADHD?
*
Anxiety
Depression
OCD
Autism
N/A
Other:
What medications are you taking for your ADHD?
*
Adderall (amphetamine/dextroamphetamine)
Adderall XR (extended-release)
Vyvanse (lisdexamfetamine)
Dexedrine (dextroamphetamine)
Evekeo (amphetamine sulfate)
Ritalin (methylphenidate)
Ritalin LA (long-acting)
Concerta (extended-release methylphenidate)
Daytrana (methylphenidate patch)
Focalin (dexmethylphenidate)
Focalin XR (extended-release dexmethylphenidate)
Quillivant XR (liquid methylphenidate)
Jornay PM (evening-administered methylphenidate)
Strattera (atomoxetine):
Intuniv (extended-release guanfacine):
Kapvay (extended-release clonidine)
Wellbutrin (bupropion)
None, I don't take any medication for my ADHD.
Other:
Required
What are your
main
concerns or challenges with ADHD?
*
Difficulty meeting work deadlines or managing projects
Strained relationships with colleagues, friends, or family
Feeling overwhelmed, stressed, or anxious
Concerns about professional reputation or advancement
Difficulty maintaining work-life balance
Increased error rates or oversight in tasks
Challenges in adapting to changes in routine or unexpected tasks
Other:
Required
What would you like to achieve
the most
through ADHD solutions/treatments? What are your personal goals?
*
Meet deadlines consistently
Foster positive relationships
Reduce stress and anxiety
Achieve work-life balance
Improve accuracy and consistency
Adapt to change and uncertainty with flexibility
Optimize productivity
Other:
Required
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Help Forms improve
Report