Autism self-assessment questionnaire (AQ-10)

Use this service to report symptoms that may indicate autism and to help your GP assess whether a referral for further support is appropriate.

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
• information about symptoms you or the person you’re completing the form for may be experiencing

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.