Title
First Name
Last Name
Email
Phone Number
Never
Rarely
Sometimes
Often
Very Often
2. How often do you have difficulty getting things in order when you have to do a task that requires organization?
Never
Rarely
Sometimes
Often
Very Often
3. How often do you have problems remembering appointments or obligations?
Never
Rarely
Sometimes
Often
Very Often
4. When you have a task that requires a lot of thought, how often do you avoid or delay getting started?
Never
Rarely
Sometimes
Often
Very Often
5. How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?
Never
Rarely
Sometimes
Often
Very Often
6. How often do you feel overly active and compelled to do things, like you were driven by a motor?
Never
Rarely
Sometimes
Often
Very Often
7. How often do you make careless mistakes when you have to work on a boring or difficult project?
Never
Rarely
Sometimes
Often
Very Often
8. How often do you have difficulty keeping your attention when you are doing boring or repetitive work?
Never
Rarely
Sometimes
Often
Very Often
9. How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?
Never
Rarely
Sometimes
Often
Very Often
10. How often do you misplace or have difficulty finding things at home or at work?
Never
Rarely
Sometimes
Often
Very Often