Illinois Institute for Integrated Mental Health

Dr. Eldin Dzudza, MD

PATIENT PORTAL
401 N. Michigan Ave., Suite 1239 • Chicago, IL
4770 N. Lincoln, Suite 7 • Chicago, IL
(312) 467-0903
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ADHD Questionnaire

Are you generally restless and unable to sit still for as long as others?
Yes

No

Do you find it hard to stop and think before doing or saying anything?
Yes

No

Are you known to have a hot temper and mood swings?
Yes

No

Is it hard for you to concentrate?
Yes

No

Do you start projects and then abandon them?
Yes

No

Are you disorganized at work and at home?
Yes

No

Have you lost jobs because of poor time-keeping?
Yes

No

Have you had more than one car accident in the past year?
Yes

No

If you answered yes to any of these questions, please contact us today to see how you can feel fine fast.

Please call my office to schedule an appointment at (312) 467-0903.

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