1. Do you often feel that you are an underachiever or have not accomplished enough in your life.

No Yes

2. Do you struggle with getting organized in your life?

No Yes

3. Do you have a tendency to put off tasks due to a fear of not doing them right?

No Yes

4. Do you often have multiple projects going on at one time but have difficulty finishing any of the projects?

No Yes

5. Do you feel very uncomfortable being bored and often look for new and exciting things to do?

No Yes

6. Do you get distracted easily and find yourself tuning out or drifting away during conversations?

No Yes

7. Do you have a low frustration tolerance and can get impatient with others quickly?

No Yes

8. Do you have a tendency to act before you think in a situation and are thought of by others as impulsive?

No Yes

9. Do people often say you have mood swings?

No Yes

10. Do you tend to have difficulty sitting still?

No Yes

11. Have you struggled with low self-esteem most of your life?

No Yes

12. Do you have difficulty staying on task when not in a structured environment?

No Yes

13. Have you always felt that you were less intelligent than others because of your lack of ability to concentrate?

No Yes

14. When you read do you 0ften have to re-read the information due to being easily distracted or daydreaming?

No Yes

15. Do you feel that even though you are easily distracted at times your concentration can be extremely intense on a specific task, to the point that you are unaware of anything else going on around you?

No Yes

16. DISCLAIMER

This Site Does Not Provide Medical Advice.

The contents of the Brookhaven Retreat, LLC (“Brookhaven”) website ( the "Content") are for informational purposes only. The Content is not intended to be a substitute for professional psychological psychiatric or medical advice, diagnosis, or treatment. Consult with your physician, psychiatrist, psychologist, or other qualified health provider without delay to gain more information regarding your specific medical and/or psychological condition.

If you think you may have a medical emergency, call your doctor or 911 immediately. Brookhaven does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by Brookhaven, Brookhaven employees, others appearing on the Site at the invitation of Brookhaven, or other visitors to the Site is solely at your own risk.

Please read and accept the terms.

I understand and agree.

User Details

Name:
Email: