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Home
About
Specialties
ADD/ADHD Counseling, Therapy or Coaching
Anxiety and Stress
Generalized Anxiety
Panic Attacks and Phobias
PTSD
Social Anxiety Disorder
Neurological Disorders
Couples and Family Counseling
Acute Stress, Trauma
ADHD Assessments, ADHD Therapy, ADHD Coaching
Brain Injury TBI
Therapy for Depression
Executive Services
Therapies
Telehealth
Couples and Family Counseling
Individual
Cognitive Behavior Therapy
Emotion-Focused Therapy
Foundational Therapies
Hypnosis
Individual IBS Therapy
Mindfulness-Based Therapy (MBCT)- Harnessing Positive Energy
Cognitive Rehabilitation
Biofeedback
Group
IBS Stress Group
Resources
Physical Health Links
Blog
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Home
About
Specialties
ADD/ADHD Counseling, Therapy or Coaching
Anxiety and Stress
Generalized Anxiety
Panic Attacks and Phobias
PTSD
Social Anxiety Disorder
Neurological Disorders
Couples and Family Counseling
Acute Stress, Trauma
ADHD Assessments, ADHD Therapy, ADHD Coaching
Brain Injury TBI
Therapy for Depression
Executive Services
Therapies
Telehealth
Couples and Family Counseling
Individual
Cognitive Behavior Therapy
Emotion-Focused Therapy
Foundational Therapies
Hypnosis
Individual IBS Therapy
Mindfulness-Based Therapy (MBCT)- Harnessing Positive Energy
Cognitive Rehabilitation
Biofeedback
Group
IBS Stress Group
Resources
Physical Health Links
Blog
roger@doctorlavine.com
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(954) 716-6702
BAARS IV Self Report Online Test
Step
1
of
11
0%
Authorized Use Only !
Full name
First
Last
Gender
*
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Female
Date of Birth
*
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1
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Email
*
Phone
*
PART 1
CURRENT SYMPTOMS
For the next 27 questions, please select the option that best describes your behavior
DURING THE PAST 6 MONTHS.
Section 1 - Inattention
For the next 9 questions, please select the option that best describes your behavior DURING THE PAST 6 MONTHS.
1. Fail to give close attention to details or make careless mistakes in my work or other activities
*
Never or Rarely
Sometimes
Often
Very Often
Question one
Q1 is symptom
2. Difficulty sustaining my attention in tasks or fun activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 2
Q2 is symptom
3. Don’t listen when spoken to directly
*
Never or Rarely
Sometimes
Often
Very Often
Question 3
Q3 is symptom
4. Don’t follow through on instructions and fail to finish work or chores.
*
Never or Rarely
Sometimes
Often
Very Often
Question 4
Q4 is symptom
5. Have difficulty organizing tasks and activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 5
Q5 is symptom
6. Avoid, dislike, or am reluctant to engage in tasks that require sustained mental effort
*
Never or Rarely
Sometimes
Often
Very Often
Question 6
Q6 is symptom
7. Lose things necessary for tasks or activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 7
Q7 is symptom
8. Easily distracted by extraneous stimuli or irrelevant thoughts.
*
Never or Rarely
Sometimes
Often
Very Often
Question 8
Q8 is symptom
9. Forgetful in daily activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 9
Q9 is symptom
Hidden
Total Section 1
Great job! You've completed section 1.
Please click the next button to continue with section 2
Section 2 - Hyperactivity
10. Fidget with hands or feet or squirm in seat
*
Never or Rarely
Sometimes
Often
Very Often
Question 10
Q10 is symptom
11. Leave my seat in classrooms or in other situations in which remaining seated is expected
*
Never or Rarely
Sometimes
Often
Very Often
Question 11
Q11 is symptom
12. Shift around excessively or feel restless or hemmed in
*
Never or Rarely
Sometimes
Often
Very Often
Question 12
Q12 is symptom
13. Have difficulty engaging in leisure activities quietly (feel uncomfortable, or am loud or noisy)
*
Never or Rarely
Sometimes
Often
Very Often
Question 13
Q13 is symptom
14. I am “on the go” or act as if “driven by a motor” (or I feel like I have to be busy or always doing something)
*
Never or Rarely
Sometimes
Often
Very Often
Question 14
Q14 is symptom
Hidden
Total Section 2
Hidden
Total symptoms section 2
Awesome! You've completed section 2.
Please click the next button to continue with section 3
Section 3 - Impulsivity
15. Talk excessively (in social situations)
*
Never or Rarely
Sometimes
Often
Very Often
Question 15
Q15 is symptom
16. Blurt out answers before questions have been completed, complete others’ sentences, or jump the gun
*
Never or Rarely
Sometimes
Often
Very Often
Question 16
Q16 is symptom
17. Have difficulty awaiting my turn
*
Never or Rarely
Sometimes
Often
Very Often
Question 17
Q17 is symptom
18. Interrupt or intrude on others (butt into conversations or activities without permission or take over what others are doing)
*
Never or Rarely
Sometimes
Often
Very Often
Question 18
Q18 is symptom
Hidden
Total Section 3
Hidden
Total Symptoms section 3
Way to go! You've completed section 3.
Please click the next button to continue with section 4
Section 4 - Sluggish Cognitive Tempo
19. Prone to daydreaming when I should have been concentrating on something or working
*
Never or Rarely
Sometimes
Often
Very Often
Question 19
Q19 is symptom
20. Have trouble staying alert or awake in boring situations
*
Never or Rarely
Sometimes
Often
Very Often
Question 20
Q20 is symptom
21. Easily confused
*
Never or Rarely
Sometimes
Often
Very Often
Question 21
Q21 is symptom
22. Easily bored
*
Never or Rarely
Sometimes
Often
Very Often
Question 22
Q22 is symptom
23. Spacey or “in a fog”
*
Never or Rarely
Sometimes
Often
Very Often
Question 23
Q23 is symptom
24. Lethargic, more tired than others
*
Never or Rarely
Sometimes
Often
Very Often
Question 24
Q24 is symptom
25. Underactive or have less energy than others
*
Never or Rarely
Sometimes
Often
Very Often
Question 25
Q25 is symptom
26. Slow moving
*
Never or Rarely
Sometimes
Often
Very Often
Question 26
Q26 is symptom
27. I don’t seem to process information as quickly or as accurately as others.
*
Never or Rarely
Sometimes
Often
Very Often
Question 27
Q27 is symptom
Hidden
Total Section 4
Hidden
Total Score
Nearly There! You've completed section 4.
Please click the next button to continue with the last section of part 1.
28. Did you experience any of these 27 symptoms at least “Often” or more frequently (Did you circle a 3 or a 4 above)?
*
Yes
No
How old were you when these symptoms began?
*
In which of these settings did those symptoms impair your functioning? Place a check mark next to all of the areas that apply to you.
*
School
Home
Work
Social Relationships
School
Please provide examples of your current difficulties
Home
Please provide examples of your current difficulties
Work
Please provide examples of your current difficulties
Social Relationships
Please provide examples of your current difficulties
Hidden
Total score for entire scale
Hidden
Sum of Sections Raw Scores 1 – 3 Total ADHD Score
Hidden
Section 1 Symptom Count
Hidden
Sum of Sections 2 and 3 Symptom Counts
Hidden
Total ADHD Symptom Count
Hidden
SCT Symptom Count
PART 1 FINISHED
Please click the next button to start part 2
PART 2
CHILDHOOD SYMPTOMS
For the next 18 questions, please select the option that best describes your behavior when you were a child
BETWEEN 5 AND 12 YEARS OF AGE.
Section 1 - Inattention
For the next 9 questions, please select the option that best describes your behavior when you were a child BETWEEN 5 AND 12 YEARS OF AGE
1. Failed to give close attention to details or made careless mistakes in my work or other activities
*
Never or Rarely
Sometimes
Often
Very Often
Question one
Q1 is symptom
2. Had difficulty sustaining my attention in tasks or fun activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 2
Q2 is symptom
3. Didn’t listen when spoken to directly
*
Never or Rarely
Sometimes
Often
Very Often
Question 3
Q3 is symptom
4. Didn’t follow through on instructions and failed to finish work or chores.
*
Never or Rarely
Sometimes
Often
Very Often
Question 4
Q4 is symptom
5. Had difficulty organizing tasks and activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 5
Q5 is symptom
6. Avoided, disliked, or was reluctant to engage in tasks that required sustained mental effort
*
Never or Rarely
Sometimes
Often
Very Often
Question 6
Q6 is symptom
7. Lost things necessary for tasks or activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 7
Q7 is symptom
8. Was easily distracted by extraneous stimuli or irrelevant thoughts.
*
Never or Rarely
Sometimes
Often
Very Often
Question 8
Q8 is symptom
9. Was forgetful in daily activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 9
Q9 is symptom
Hidden
Total Part 2 Section 1
Hidden
Total symptoms Part 2 Section 1
Great job! You've completed section 1.
Please click the next button to continue with section 2
Section 2 - Hyperactivity-Impulsivity
For the next 9 questions, please select the option that best describes your behavior when you were a child BETWEEN 5 AND 12 YEARS OF AGE
10. Fidgeted with hands or feet or squirmed in seat
*
Never or Rarely
Sometimes
Often
Very Often
Question 10
Q10 is symptom
11. Left my seat in classrooms or in other situations in which remaining seated was expected
*
Never or Rarely
Sometimes
Often
Very Often
Question 11
Q11 is symptom
12. Shifted around excessively or felt restless or hemmed in
*
Never or Rarely
Sometimes
Often
Very Often
Question 12
Q12 is symptom
13. Had difficulty engaging in leisure activities quietly (felt uncomfortable, or was loud or noisy)
*
Never or Rarely
Sometimes
Often
Very Often
Question 13
Q13 is symptom
14. Was “on the go” or acted as if “driven by a motor”
*
Never or Rarely
Sometimes
Often
Very Often
Question 14
Q14 is symptom
15. Talked excessively
*
Never or Rarely
Sometimes
Often
Very Often
Question 15
Q15 is symptom
16. Blurted out answers before questions had been completed, completed others’ sentences, or jumped the gun
*
Never or Rarely
Sometimes
Often
Very Often
Question 16
Q16 is symptom
17. Had difficulty awaiting my turn
*
Never or Rarely
Sometimes
Often
Very Often
Question 17
Q17 is symptom
18. Interrupted or intruded on others (butted into conversations or activities without permission or took over what others were doing)
*
Never or Rarely
Sometimes
Often
Very Often
Question 18
Q18 is symptom
Hidden
Part 2 Total Section 2
Hidden
Part 2 Total symptoms section 2
Awesome! Only one more step to go
Please click the next button to answer the last questions
19. Did you experience any of these 18 symptoms at least “Often” or more frequently (Did you circle a 3 or a 4 above)?
*
Yes
No
How old were you when these symptoms began?
*
In which of these settings did those symptoms impair your functioning? Place a check mark next to all of the areas that apply to you.
*
School
Home
Social Relationships
School
Please provide examples of your current difficulties
Home
Please provide examples of your current difficulties
Social Relationships
Please provide examples of your current difficulties
Hidden
Part 2 - Total score for entire scale
Hidden
Sum of Sections 1 – 2 for Total Scores
Hidden
Sum of Sections 1 – 2 for Symptom Counts
Great, you've made it.
Just click the submit button below to send the results to dr Lavine and he will reach out to you shortly.
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BAARS IV Other Report Online Test
DASS 42 ONLINE TEST
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roger@doctorlavine.com
(954) 716-6702
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