Summit Research Network

Trouble paying attention to details or carelessness	Yes	No
Touble sustaining attention	Yes	No
Not seeming to listen	Yes	No
Not following through well on tasks	Yes	No
Having trouble organizing activities	Yes	No
Disliking tasks requiring sustained mental effort	Yes	No
Losing things needed for tasks	Yes	No
Becoming easily distracted	Yes	No
Becoming forgetful	Yes	No
Fidgeting or squirming frequently	Yes	No
Having trouble playing quietly	Yes	No
Seeming to be always 'on the go'	Yes	No
Talking excessively	Yes	No
Acting without thinking	Yes	No

If you have experienced several of these symptoms since childhood and the symptoms are disruptive to your life, you may have ADHD.

Summit Research Network participates in research studies of investigational medication for ADHD. If you are selected, all research-related care and study medications will be provided at no cost. If you would like more information, please call us at (206) 292-CARE (2273), or fill out the form below and we will contact you.

All information you may provide is stored in a secure site, and cannot be released to any third party without your written and signed authorization.

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