ADHD + Autism Assessment Form

First Name *

Last Name *

Phone *

Email *

Zip Code *

Why are you seeking an evaluation for Autism or ADHD at this time? *

What specific challenges or symptoms are you hoping to understand better through this assessment? *

Are you looking for a diagnosis to pursue accommodations in a workplace or educational setting? If so, can you specify what type? *

Are you seeking this assessment for personal insight, or do you have specific external requirements (like legal or disability claims) that need to be met? *

Have you had any previous evaluations or diagnoses for Autism, ADHD, or related conditions? If so, what were they, and how have they influenced your current needs? *

Are you currently receiving any mental health treatment? If so, what kind? *

How do you plan to use the results of this assessment? *

Are you aware that this assessment is for personal insight and may not meet the requirements for formal diagnoses needed for government-related purposes? *

Do you have any specific expectations from the assessment that may not align with what an LCSW can provide? *

Is there anything else about your situation that you think is important for me to know before proceeding with the assessment? *

Before You Submit

This evaluation is for adults 18+ seeking clarity, insight, or a formal diagnosis for ADHD and/or Autism in an affirming, neurodiversity-informed way. An evaluation with DBT of South Jersey is not designed to meet requirements for things like disability claims, IEPs, or workplace accommodations, as that is often required by a psychologist or psychiatrist. It can be a powerful starting point for understanding yourself and your needs before you pursue further diagnostic work.

I understand this is a diagnostic evaluation for personal insight and clarity, and may not meet criteria for legal, educational, or government-related documentation.