Assessment

Vanderbilt ADHD Assessment

2 pages•18 fields
Editable templateCustomize in minutes

Clinical review required: this worksheet does not calculate scores, diagnose, or recommend treatment. Confirm the questions and response options against your approved assessment protocol before use.

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Vanderbilt ADHD Assessment

Page 1 of 2

Child's Name
Jane Martinez
Date of Birth
03/15/1985
Relationship to Child
Select relationship...
Fails to give attention to details
Enter details here...
Difficulty sustaining attention in tasks
Enter details here...
Does not seem to listen when spoken to
Enter details here...
Difficulty organizing tasks and activities
Enter details here...
Easily distracted by extraneous stimuli
Enter details here...
Fidgets with hands or feet
Enter details here...
Leaves seat when remaining seated is expected
Enter details here...
Runs or climbs in inappropriate situations
Enter details here...
Talks excessively
Enter details here...
Blurts out answers before questions are completed
Enter details here...
Difficulty waiting turn
Enter details here...
Academic Performance
Enter details here...
Classroom Behavior
Enter details here...
Peer Relationships
Enter details here...
Organizational Skills
Enter details here...
Submit
Use this template

Sign up and start customizing in minutes.

Start with the Vanderbilt ADHD Assessment template and tailor it to your practice. It includes 18 editable fields across 2 pages. Included questions: Child's Name, Date of Birth, Relationship to Child, Fails to give attention to details. The full field list below shows what you will get when you add this template to your account.

Choose this template to open an editable form. Review the questions, keep only the information your practice needs, and add your branding. Preview the patient experience before sharing a link or embedding the form. Responses can be reviewed in Formisoft and exported as a PDF.

Clinical review required: this worksheet does not calculate scores, diagnose, or recommend treatment. Confirm the questions and response options against your approved assessment protocol before use.

What's included

  • Child's Name
  • Date of Birth
  • Relationship to Child
  • Fails to give attention to details
  • Difficulty sustaining attention in tasks
  • Does not seem to listen when spoken to
  • Difficulty organizing tasks and activities
  • Easily distracted by extraneous stimuli
  • Fidgets with hands or feet
  • Leaves seat when remaining seated is expected
  • Runs or climbs in inappropriate situations
  • Talks excessively
  • Blurts out answers before questions are completed
  • Difficulty waiting turn
  • Academic Performance
  • Classroom Behavior
  • Peer Relationships
  • Organizational Skills

Who uses this template

  • Pediatric practices conducting initial ADHD diagnostic evaluations
  • Child psychiatry clinics monitoring medication response and side effects
  • School-based health centers supporting educational accommodation referrals
  • Developmental-behavioral pediatrics assessing comorbid conditions

All form fields

18 fields across 2 pages. Customize any field after signing up.

Child's NameText
Date of BirthDate
Relationship to ChildDropdown
Fails to give attention to detailsLong Text
Difficulty sustaining attention in tasksLong Text
Does not seem to listen when spoken toLong Text
Difficulty organizing tasks and activitiesLong Text
Easily distracted by extraneous stimuliLong Text
Fidgets with hands or feetLong Text
Leaves seat when remaining seated is expectedLong Text
Runs or climbs in inappropriate situationsLong Text
Talks excessivelyLong Text
Blurts out answers before questions are completedLong Text
Difficulty waiting turnLong Text
Academic PerformanceLong Text
Classroom BehaviorLong Text
Peer RelationshipsLong Text
Organizational SkillsLong Text

How to use the Vanderbilt ADHD Assessment

Getting started with this template takes just a few minutes. Sign up for a Formisoft trial, then select the Vanderbilt ADHD Assessment from the template library. Review the included questions, customize your fields, and preview the form before sharing it.

Setup steps

  1. 1Choose the template. Find the Vanderbilt ADHD Assessment in the template library and click “Use this template” to add it to your account.
  2. 2Customize fields. Add, remove, or reorder any of the 18 fields. Set fields as required or optional based on your practice needs.
  3. 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
  4. 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
  5. 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.

Frequently asked questions

How does Formisoft protect responses?

Formisoft provides secure form collection and a Business Associate Agreement (BAA). Your practice must review the form content, access permissions, and sharing workflow for its requirements.

Can I customize the fields in this template?

Absolutely. You can add, remove, reorder, or modify any of the 18 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

How do patients fill out this form?

Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.

Can I send this form automatically before appointments?

With a plan that includes automation, you can configure workflows to send forms and reminders. Appointment-based sending requires the booking event to reach Formisoft.

Does this template work on mobile devices?

Yes. The Vanderbilt ADHD Assessment is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.

Start with this template

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