Only nonstimulants can be prescribed via this visit type

For stimulants please make an appointment.

1 - How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?*

• 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
  

11 - How often are you distracted by activity or noise around you?*

• Never
  Rarely
  Sometimes
  Often
  Very Often
  

12 - How often do you leave your seat in meetings or other situations in which you are expected to remain seated?*

• Never
  Rarely
  Sometimes
  Often
  Very Often
  

13 - How often do you feel restless or fidgety?*

• Never
  Rarely
  Sometimes
  Often
  Very Often
  

14 - How often do you have difficulty unwinding and relaxing when you have time to yourself?*

• Never
  Rarely
  Sometimes
  Often
  Very Often
  

15 - How often do you find yourself talking too much when you are in social situations?*

• Never
  Rarely
  Sometimes
  Often
  Very Often
  

16 - When you’re in a conversation, how often do you find yourself finishing the sentences of the people you are talking to, before they can finish them themselves?*

• Never
  Rarely
  Sometimes
  Often
  Very Often
  

17 - How often do you have difficulty waiting your turn in situations when turn taking is required?*

• Never
  Rarely
  Sometimes
  Often
  Very Often
  

18 - How often do you interrupt others when they are busy?*

• Never
  Rarely
  Sometimes
  Often
  Very Often
  

19 - Please enter preferred pharmacy information.*

• 
  
Include a complete information where you would like to pick up your medication.

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• Proceed to payment