ADHD self-report scale (ASRS)

Please use this service to complete a checklist of symptoms that may be linked to ADHD. If you are keen to explore a formal assessment for ADHD and your ADHD symptoms are affecting your studies, work or relationships, we would be grateful if you could complete this form. Your results will be reviewed by a GP. You may be invited to attend an appointment or we will be touch to arrange a referral directly to your chosen provider.

You can use this service if you:

• are registered at the surgery

Before you start

We’ll ask you for:

• your first and last name, date of birth, sex, postcode, email and phone number
• if applicable, the details of the person you are completing the form on behalf of
• responses to a series of questions about common ADHD symptoms

Start now

You can also phone us on Windsor House Surgery 0333 242 7777 or Shenstone House Surgery 0333 242 7777 or Adwalton House Surgery 0333 242 7777.