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ADHD Pre Assessment Form

This form is designed to gather essential background information that will assist in creating a comprehensive ADHD assessment tailored to your needs. The information collected includes personal details, health history, and current challenges, ensuring that our team and any third-party assessors involved can fully understand your situation and provide effective support.  

Data Processing and Sharing with Third Parties

 

We, The Diverse Creative CIC, are committed to protecting your personal data and ensuring compliance with the General Data Protection Regulation (GDPR). By submitting this form, you acknowledge and agree to the following:

  • The information you provide will be processed and securely stored by The Diverse Creative CIC in accordance with GDPR.

  • We will only collect and process the personal data necessary for your assessment and support.

  • To provide the best possible service, your information may be shared with a third-party assessor, who will assist in conducting your assessment. The third party will only use this information for the purpose of the assessment and will also be required to comply with GDPR.

  • Your data will not be shared with any other parties without your explicit consent, unless required by law.

  • You have the right to request access to, correction of, or deletion of your personal information at any time, as well as to withdraw your consent for data processing.

If you have any questions or concerns about how your data will be used, please contact us at info@thediversecreative.org.By completing and submitting this form, you consent to The Diverse Creative CIC processing and sharing your information as outlined above.

Personal Information
Demographics
Employment & GP Information
Health Information
Substance Use & Legal History
Physical & Mental Health
Well-being & Daily Life
How Is Your Mood? 1 being very low/bad, 5 being very high/good
How are your sleep and appetite? 1 being very bad, 5 being very good
Do you feel hopeful about your future? 1 being not at all, 5 being very hopeful
Your Goals
Consent
Declaration

Signature

Additional Information
Select File

Once submitted, you will directed to a payment page. In order for your assessment to be booked, you will be required to make payment in full. If you have any questions, Please contact us. 

Your pre assessment form has now been submitted and you will be forward to the payment form.

An error occurred. Please ensure all required field are completed before submitting. 

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