About this template
The Adult ADHD Investigator Symptom Rating Scale (AISRS) is a standardized clinical tool used by healthcare professionals to assess the severity of ADHD symptoms in adult patients. This Google Form template digitizes the traditional AISRS, allowing clinicians to efficiently record symptom severity scores during or after patient evaluations. By moving to a digital format, practitioners can maintain consistent data collection, track patient progress over time, and reduce the administrative burden associated with paper-based assessments.
This template covers the full range of ADHD diagnostic criteria, including both inattentive and hyperactive-impulsive symptom clusters. Each item is structured to capture severity levels, ensuring that the rater provides a clear, quantifiable assessment for every clinical marker. Designed for ease of use, this form helps clinicians focus on the patient interaction rather than manual data entry, providing a clean, organized output that can be easily integrated into clinical workflows.
Key features
- Standardized AISRS symptom criteria for consistent evaluation.
- Clear scale-based questions for rapid symptom severity scoring.
- Includes dedicated fields for rater identification and verification.
- Mobile-friendly design for use on tablets during clinical sessions.
- Easily exportable data for longitudinal patient tracking.
Use cases
- Initial diagnostic evaluations for adult ADHD.
- Monitoring symptom progression during medication management.
- Clinical research studies requiring standardized symptom reporting.
- Therapeutic progress reviews for ADHD coaching.
What this form collects
- Rater Full Name (Short answer)Enter the name of the clinician performing the assessment.
- Date of Assessment (Date)Select the date the assessment was conducted.
- Careless Mistakes (Linear scale)Difficulty paying close attention to details or making careless mistakes.
- Fidgeting/Squirming (Linear scale)Fidgets with hands or feet or squirms in seat.
- Sustained Attention (Linear scale)Difficulty sustaining attention in tasks or play activities.
- Leaving Seat (Linear scale)Leaves seat in classroom or in other situations in which remaining seated is expected.
- Listening/Concentration (Linear scale)Does not seem to listen when spoken to directly.
- Restlessness (Linear scale)Feelings of restlessness or inability to sit still.
- Finishing Tasks (Linear scale)Does not follow through on instructions and fails to finish schoolwork or chores.
- Relaxing/Unwinding (Linear scale)Difficulty engaging in leisure activities quietly.
- Organization Difficulty (Linear scale)Difficulty organizing tasks and activities.
- Driven by a Motor (Linear scale)Is 'on the go' or acts as if 'driven by a motor'.
- Task Initiation Avoidance (Linear scale)Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort.
- Talking Too Much (Linear scale)Talks excessively.
- Misplacing Things (Linear scale)Loses things necessary for tasks or activities.
- Interrupting/Blurting (Linear scale)Blurts out answers before questions have been completed.
- Distractibility (Linear scale)Easily distracted by extraneous stimuli.
- Waiting Turn Difficulty (Linear scale)Difficulty awaiting turn.
- Forgetfulness (Linear scale)Forgetful in daily activities.
- Interrupting Others (Linear scale)Interrupts or intrudes on others.
- Clinical Notes (Paragraph)Add any additional observations or clinical context here.
FAQ
Is this form suitable for self-diagnosis?
No. The AISRS is an investigator-rated scale designed to be completed by a trained healthcare professional based on clinical observation and patient interview.
Can I customize the scale labels?
Yes. Once you copy this template to your Google Drive, you can modify the scale labels or add specific clinical notes fields to suit your practice's requirements.
How do I ensure the security of this clinical data?
Ensure your Google Workspace account is configured with appropriate administrative security settings and that you are following your organization's internal data privacy policies.
Can I use this form on a tablet during a patient visit?
Yes, Google Forms are fully responsive and work seamlessly on tablets, making it easy to record ratings in real-time during a consultation.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.