ADHD Referral Request

Are there any members of your family that have been diagnosed with ADHD? *

The symptoms of attention deficit hyperactivity disorder (ADHD) can be categorised into 2 types of behavioural problems:

  • Inattentiveness (difficulty concentrating and focusing) – e.g. short attention span, constantly changing activities or tasks, difficulty organising tasks, appearing forgetful and losing things, making careless mistakes, being unable to stick to tasks that are tedious or time-consuming.
  • Hyperactivity and impulsiveness – e.g. acting without thinking, being unable to sit still, excessive talking, little or no sense of danger, being unable to concentrate on tasks.

Please give a detailed account of when you have presented with these symptoms or similar and how this has impacted your daily life.

Do you have any sleep problems? *
Have you suffered from mental health problems such as depression and anxiety or any other mental health problems? *
Have you been diagnosed with any learning difficulties (e.g. dyslexia)? *
Have you been diagnosed with any neurodevelopmental disorders (Tourette’s syndrome, epilepsy, autistic spectrum disorder (ASD), dyspraxia, head injury)? *
Do you have any physical health problems? *
Do you have any past or present history of misusing alcohol or illicit substances? *
Do you have any past or present forensic history, including driving offences? *
Please upload any relevant documentation:
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