General Health


General Health




Diagnosed with ADD?


If so, Do You Use Meds?


Others in Family w/ADD?
List Your ADD Support Team




Current or Previous Problems with Depression?


Current or Previous Problems with Alcohol or Drugs?
Any Family History of the Above?



Quality of Relationships with Family and Friends?


_____ Poor          _____Fair          _____Good          _____Excellent

Describe Your Workspace





Any Sleep Problems?
Describe Your To-Do List or Number of Projects in Process





Are You Always On Time or Always Late?



Are You Impulsive?  When?



Have You Worked with a Counselor/Therapist?



How Do You Like to Learn?  (Visual – see the picture or color, Tactile – touch, Auditory – hear, Verbal – speak out loud and free-associate, Kinesthetic – moving and doing, Cerebral – think about the big picture and make sense of the puzzle)