ADHD - Child - Almond Group Practice

Please complete this form if you think that your child may have the condition ADHD. It will take around 20 minutes of your time so please ensure you set aside this time in advance.

On Completion. We will assess the likelihood of ADHD and book you and your child for a GP consultation. There are two outcomes:

We do not think your child has ADHD and we may give other advice.
We think your child is likely to have ADHD. We will refer you to the Child and Adolescent Mental Health Service (CAMHS). Unfortunately there is currently a waiting list for this specialty of around 2 years. In the meantime it is recommended you download and read the useful
ADHD Resource Pack

The Form. Made of THREE sections:

The Child’s Details
School Report / Assessment*
The Child’s Symptoms

*School reports are very helpful in the assessment and referrals benefit from having these included. Please have these to hand to upload into this form or hand them into the practice afterwards for us to copy and upload.

This review works well on mobile but it is easier on a computer.

Tick here if you would like to email yourself this review to complete on computer. (Instant)

Your Email

CAMHS does not accept referrals for children who have not attended at least one term of school

My child is 5 years old or older and has attended at least one school term

CAMHS does not consider ADHD referrals for children who use alcohol or drugs.

I confirm there is no alcohol or drug use

CHILD’S DETAILS

Patient Name (Child’s)

Date of Birth (Child’s)

Who is the child’s usual GP?

Mobile number to contact you

Your name

Your relationship to the child

If you are not the child’s parent please give a brief description of the reason that they are in your care.

Who else lives in the home?

School that the child attends

School Year

Email (If you’d like a copy of the review)

SCHOOL REPORT / ASSESSMENT

File Upload

Maximum file size: 52.43MB

CHILD’S SYMPTOMS

Please now tell us why you think your child has ADHD.

Attention Deficit Hyper-activity Disorder is characterised by pervasive lack of attention, impulsivity, and hyperactivity across more than one situation and setting – at home, school, and in public – which began before 7 years of age. Please now give us some information on these specific areas even if it means slightly repeating yourself.

Please tell us about any ATTENTION problems in the home, school and in public.

Please tell us about any IMPULSIVITY problems in the home, school and in public.

Please tell us about any HYPERACTIVITY problems in the home, school and in public.

This form collects your name, date of birth, email, other personal information and medical details. This is to confirm you are registered with the practice, to allow the practice team to contact you and also to update your medical records held by the practice and our partners in the NHS. Please read our privacy policy to discover how we protect and manage your submitted data.

Consent

I agree to the privacy policy

CAPTCHA