Adult Autism / ADHD Pre-Assessment Anamnesis Form

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This form is designed to gather detailed information from adults seeking assessment for autism, ADHD, or both. It encompasses key areas including basic information, reasons for seeking assessment, psychiatric history, and assessment logistics and technical considerations.

All information provided in this form will be kept strictly confidential and used solely for the purpose of your assessment.

Completing this form thoroughly helps ensure an effective and efficient assessment.

Put 0 if none.
For example: depression, anxiety, trauma, obsessive thoughts or behaviors, bipolar symptoms, panic attacks, eating-related concerns, personality-related difficulties, stress-related symptoms, etc.
Psychiatric medications, non-psychiatric medical medications, supplements if applicable
Please select all that apply.
If yes, please specify the relation (e.g., parent, sibling, cousin) and the diagnosis.
It is recommended to have a pen, paper, or notes available during the assessment.
It is recommended that you attend the assessment alone, except for the final part where a parent or caregiver familiar with your developmental history may join.

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