Free printable
Bring-to-your-appointment packet for ADHD testing
Three short forms that make the clinical interview more accurate: a history worksheet for you, a teacher observation form for your child’s school, and a form for someone who knew you as a child if you are an adult. Print all three, fill in what you can, and bring them to session one along with the symptom checklist. Nothing here is scored or diagnostic; it is memory support for a conversation that covers a lot of years.
Form 1: History worksheet (everyone)
Short answers are fine. Leave blank what you do not know.
Name and date of birth
Who referred you, and what prompted the evaluation now?
Earliest age anyone noticed attention, activity, or behavior concerns; who noticed?
School history: grades, retention, special services, comments teachers repeated year after year
Current medications and supplements (name, dose, how long)
Sleep: usual bedtime, wake time, snoring, trouble falling or staying asleep
Medical history: head injuries, seizures, thyroid, hearing or vision problems, premature birth
Prior mental health diagnoses or treatment (anxiety, depression, trauma, learning disability)
Family history: ADHD, learning disabilities, anxiety, depression, substance use in blood relatives
Caffeine, nicotine, alcohol, cannabis: typical weekly use
Work or school now: what is going well, what is falling apart
Relationships: what the people closest to you would say the problem is
What you hope the evaluation will change
Form 2: Teacher observation form (children and teens)
Give to a current teacher who sees the student most days. Rate the past six months compared with other students the same age.
Student: ______________________ Grade: _____ Teacher / subject: ______________________ Date: __________
Has trouble staying on task during independent workNever ☐ Sometimes ☐ Often ☐ Very often ☐
Does not finish assignments in the time givenNever ☐ Sometimes ☐ Often ☐ Very often ☐
Loses or forgets materials, homework, or instructionsNever ☐ Sometimes ☐ Often ☐ Very often ☐
Appears not to listen when addressed directlyNever ☐ Sometimes ☐ Often ☐ Very often ☐
Makes careless errors on work they understandNever ☐ Sometimes ☐ Often ☐ Very often ☐
Fidgets, leaves seat, or is out of place in the roomNever ☐ Sometimes ☐ Often ☐ Very often ☐
Talks out of turn, blurts answers, interruptsNever ☐ Sometimes ☐ Often ☐ Very often ☐
Difficulty waiting for a turn or transitioning between activitiesNever ☐ Sometimes ☐ Often ☐ Very often ☐
Emotional reactions larger than the situation calls forNever ☐ Sometimes ☐ Often ☐ Very often ☐
Difficulty with peers (rejected, conflicts, isolated)Never ☐ Sometimes ☐ Often ☐ Very often ☐
Academic performance compared with apparent ability (well below / somewhat below / matches)
Supports already in place (seating, extended time, check-ins, 504, IEP)
Anything else you want the evaluator to know
Form 3: Childhood informant form (adults)
Give to a parent, older sibling, or anyone who knew you well before age 12. ADHD is a developmental diagnosis, and their memory fills gaps yours cannot.
About: ______________________ Completed by: ______________________ Relationship: ____________
As a child, had trouble sitting through meals, church, or car ridesNever ☐ Sometimes ☐ Often ☐ Very often ☐
Homework took far longer than it should have or caused nightly conflictNever ☐ Sometimes ☐ Often ☐ Very often ☐
Teachers commented on daydreaming, not listening, or unfinished workNever ☐ Sometimes ☐ Often ☐ Very often ☐
Lost things constantly (coats, homework, lunch money)Never ☐ Sometimes ☐ Often ☐ Very often ☐
Was described as "in their own world" or "a motor that never stopped"Never ☐ Sometimes ☐ Often ☐ Very often ☐
Reacted to correction or disappointment much more strongly than siblingsNever ☐ Sometimes ☐ Often ☐ Very often ☐
Was bright but grades did not reflect itNever ☐ Sometimes ☐ Often ☐ Very often ☐
Struggled with friendships or was frequently in conflict with peersNever ☐ Sometimes ☐ Often ☐ Very often ☐
Anything a teacher, coach, or pediatrician said back then that stuck with you
Anyone else in the family with similar traits, diagnosed or not
Prepared by Dr. Andrew Wichterman, PhD, LPC, for use before an ADHD evaluation. Not a rating scale and not diagnostic. Last reviewed September 9, 2026.
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