ADHD Screening Form -

Child's name

Child's date of birth

Parents/s or carer/s email address

Parent/s or carer/s contact telephone number

Child's home address

Please provide the name of the school your child attends

Does your child have any physical or mental health diagnoses?

Yes

If yes, please give details

Has your child ever had any serious illnesses or accidents/injuries?

Yes

If yes, please give details

Please list any behaviours you have noted that have prompted you to seek an ADHD Screening service. Please describe these in as much detail as you can, listing how long they have been present for

Has your child's school raised any concerns about your child's behaviour within school? If yes, please provide further details

Have you spoken to a professional about your concerns? If yes, what type of professional did you speak to and what advice were you given?

Are you currently on any NHS waiting list for a formal ADHD Assessment? If yes, please share where you are at in the process and if any screening questionnaires, meetings or feedback have taken place

Does your child have friends or do they have difficulties with friendships? Please describe

ADHD Screening Form and Consent