F. David Hannanian, M.D. PC

Adult ADHD Symptom Checklist

Adult ADHD Self-Report Scale (ASRS-v1.1)

475 Northern Blvd., Suite 18
Great Neck, NY 11021
(516) 773-3048

Please answer each question using the scale shown. Choose the answer that best describes how you have felt and conducted yourself over the past 6 months. Give your completed checklist to your healthcare professional to discuss during your appointment.

0 of 18 answered

Part A

Questions 1–6

Part B

Questions 7–18

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This checklist records your answers for discussion with your healthcare professional. It does not provide a diagnosis.