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  • Home
  • Scripts
  • Forms
    • Parents
      • Parent New Assessment Form
      • Parent Follow-up Form
      • ADHD in GIRLS and WOMEN
      • Adult ADHD
      • MCHAT SCREEN for Autistic Spectrum Disorder
      • Video interview consent
    • Teachers
      • Teachers new patients
      • Teacher Follow-up Form

Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist

Please answer the questions below, rating yourself on each of the criteria. As you answer each question, select the single choice that best describes how you have felt and conducted yourself over the past 6 months. This form can be be submitted and can be discussed during your next appointment with Dr. Flett

Step 1 of 19

5%
  • Name of person reporting on
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    DD slash MM slash YYYY
    This autism test is designed to screen the possibility of ASD, and is for personal use only. This is not a diagnostic tool. An accurate diagnosis can only be made through clinical evaluation. This autism test is for personal use only.
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  • Symptoms highly consistent with ADHD in adults and further investigation is warranted.

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