ASRS ASRS v. 1.1 ASRS v 1.1 Email to receive your copy (Optional) Confirm Email to receive your copy (Optional) Enter a confirmation email address. Date * Patient Name * Part A 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 Part B 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 If you are human, leave this field blank. Submit