Screening

Vanderbilt ADHD Assessment Screening

2 pages•14 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.

Form Preview

formisoft.com/f/vanderbilt-adhd-screening

Vanderbilt ADHD Assessment Screening

Page 1 of 2

Child's Name
Jane Martinez
Date of Birth
03/15/1985
Child's Age
0
Grade Level
Enter details here...
Parent/Guardian Name
Jane Martinez
Difficulty sustaining attention
Enter details here...
Does not seem to listen
Enter details here...
Easily distracted
Enter details here...
Fidgets with hands or feet
Enter details here...
Runs or climbs excessively
Enter details here...
Talks excessively
Enter details here...
Oppositional Behavior Items
Enter details here...
Academic Performance Rating
Enter details here...
Social Relationships Rating
Enter details here...
Submit
Use this template

Sign up and start customizing in minutes.

Start with the Vanderbilt ADHD Assessment Screening template and tailor it to your practice. It includes 14 editable fields across 2 pages. Included questions: Child's Name, Date of Birth, Child's Age, Grade Level. 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
  • Child's Age
  • Grade Level
  • Parent/Guardian Name
  • Difficulty sustaining attention
  • Does not seem to listen
  • Easily distracted
  • Fidgets with hands or feet
  • Runs or climbs excessively
  • Talks excessively
  • Oppositional Behavior Items
  • Academic Performance Rating
  • Social Relationships Rating

Who uses this template

  • Pediatric primary care ADHD evaluation and diagnosis
  • Child psychiatry and developmental-behavioral pediatrics intake
  • School-based ADHD assessment and IEP documentation
  • Family medicine ADHD screening for school-age children

All form fields

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

Child's NameText
Date of BirthDate
Child's AgeNumber
Grade LevelLong Text
Parent/Guardian NameText
Difficulty sustaining attentionLong Text
Does not seem to listenLong Text
Easily distractedLong Text
Fidgets with hands or feetLong Text
Runs or climbs excessivelyLong Text
Talks excessivelyLong Text
Oppositional Behavior ItemsLong Text
Academic Performance RatingLong Text
Social Relationships RatingLong Text

How to use the Vanderbilt ADHD Assessment Screening

Getting started with this template takes just a few minutes. Sign up for a Formisoft trial, then select the Vanderbilt ADHD Assessment Screening 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 Screening 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 14 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 14 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 Screening 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

Sign up and start customizing the Vanderbilt ADHD Assessment Screening for your practice. Set up in minutes.

Related templates

Vanderbilt ADHD Assessment ScreeningUse this template