After completing this questionnaire, sending your results takes two steps:
Step 1: Download - Tap "Download results file" to save it to this device.
Step 2: Email - Tap "Open email to Dr. Shah", attach the file you just downloaded, and send. Your email will not attach it for you.
If you prefer, you can email the file yourself to [email protected].
Important Notice:
This questionnaire is for information gathering purposes only and is not diagnostic. The responses you provide will be reviewed by your clinician as part of a comprehensive clinical assessment. Only a qualified healthcare professional can make diagnostic or treatment decisions. Please answer honestly based on your actual experiences.
Privacy: All data is processed locally on your device. Nothing is sent anywhere until you choose to download and share your results file with your clinician. Your answers are also saved automatically on this device as you go, so you can close this page and come back later to finish.
📝 Answering Questions: You may leave questions blank if you're unsure or they don't apply to you. Don't guess - skipped items will be excluded from score calculations. However, try to answer as many as you can for accurate results.
0 of 54 items answered (54 skipped) (0%)
Your Information
Part 1: Current Behaviour (Past 6 Months)
Instructions: Rate your behaviour during the past six months
0 = Never/rarely1 = Sometimes2 = Often3 = Very often (several times per hour/day)
Age When Problems Began
Impact on Daily Life (Current)
To what extent do these behaviours interfere with your ability to function in each area?
0 = Never/rarely1 = Sometimes2 = Often3 = Very often (several times per hour/day)
Part 2: Childhood Behaviour (Ages 7-12)
Important: Rate your behaviour between 7 and 12 years of age. Try to remember how you were during those childhood years.
0 = Never/rarely1 = Sometimes2 = Often3 = Very often (several times per hour/day)
Impact on Daily Life (Childhood, ages 7-12)
To what extent did these behaviours interfere with your functioning between ages 7-12?
0 = Never/rarely1 = Sometimes2 = Often3 = Very often (several times per hour/day)
0 of 54 items answered (54 skipped) (0%)
✓ Latest response recorded
✓ Questionnaire Complete
Thank you for completing this questionnaire
Your responses have been saved. Please send your results to Dr. Shah using one of the options below.
Your clinician will review these results and schedule the next step (a structured clinical interview) before any diagnostic conclusions can be reached.
Send Results to Dr. Shah:
Before you send: attach your file
Your email does not attach the file for you. Please attach the file below to your email, then send.
The file to attach (saved to this device just now):
If it saved as .bin or .txt instead of .enc, that is fine, your clinician can still open it.
How to send: First tap "Download results file". Then tap "Open email to Dr. Shah", attach the downloaded file shown above, and send. If you prefer, you can email the file to [email protected] yourself.