Adult ADHD questionnaire for referral
For a referral to the mental health Adult Attention Deficit Hyperactivity Disorder (ADHD) service the patient is required to complete the following questions
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The questions asked may feel sensitive. However, it is important that these questions are asked to ensure the surgery can make the best assessment. Your answers are completely confidential
Your Details
Please include your latest personal details so that we can contact you if necessary. Failure to do so may result in the surgery not being able to contact you back regarding your symptoms
Your Full Name *
Your Date of Birth *
Please include your DOB in the form of dd/mm/yyyy i.e 01/01/1980
Your Mobile number *
In order to contact you we need your latest mobile number
Your Email Address *
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