ADHD Self-Report Scale 
Please answer the questions below, rating yourself on each of the criteria shown using the scale on the left side of the page. As you answer each question, place select the option that best describes how you have felt and conducted yourself over the past 6 months.
Remember the answers are private, and only your counsellor can access them.

Although the questionnaire is indicative, it should NOT be used as a diagnostic tool in this context. Rather this assessment can be an important initial step in getting further support.  Indeed, It is common for people to hesitate to seek help because they fear their concerns aren't legitimate or severe enough.

If you have any questions or concerns about the questionnaire, contact email us
 
Please read our privacy policy.
Sign in to Google to save your progress. Learn more
Email *
Name, Surname , Gender and Age 
*
Date 
*
MM
/
DD
/
YYYY
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of ACT Right Now Counselling Services . Report Abuse