Adult ADHD - Information needed for GP

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Right to choose

Adult ADHD Questionnaire

For a Right to Choose ADHD assessment, some providers require a questionnaire to be done prior to the referral (ASRS).  

  • Please could you give us a copy of this questionnaire if your provider requires it, if not – please complete this form.
  • Please note that the ASRS questionnaire on this page is for adults only. If this referral is for your child and the provider you have selected does not have any questionnaire, there is no need to do anything else besides answer the following questions.
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All questions marked with a * are mandatory

Personal Details
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ADHD Questions
Is there any evidence of symptom onset in childhood (< 12 years old): *
Examples such as substance use, forensic history, relationship difficulties, failing in work/study
(including any diagnosis, past or current support from a local mental health team e.g. CMHT, IAPT)
(employment status, in education, independent living skills)

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

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