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ADHD
This page is to help us have better communication with our teachers to improve the quality of care we can offer our patients. This page will be updated with links to valuable information as well as have forms available for patient evaluation.
ADHD Teacher Evaluation
Please complete this form and submit it.
Student Name:
*
Today's Date:
*
Teacher Name:
*
Teacher Passcode:
*
Student Behavior:
Excellent
Good, no big problems
Needs Improvement
Very Difficult to Handle
Inattentive or Easily Distracted:
Not at all
Just a Little
Often
Very Often
Angry or resentful::
Not at all
Just a Little
Often
Very Often
Difficulty completing work::
Not at all
Just a Little
Often
Very Often
Short Attention Span:
Not at all
Just a Little
Often
Very Often
Fidgets with hands/feet:
Not at all
Just a Little
Often
Very Often
Loses Temper Easily:
Not at all
Just a Little
Often
Very Often
Disrespectful to adults:
Not at all
Just a Little
Often
Very Often
Shows Violent Behavior:
Not at all
Just a Little
Often
Very Often
Any additional concerns:
Security Code:
(Please enter # as indicated)*
Some places you can visit for information:
American Academy of Pediatrics
CDC ADHD Page