Forms & Assessment Tools

NICHQ - Vanderbilt

The NICHQ Vanderbilt Assessment Scales are used by health care professionals to help diagnose ADHD in children between the ages of 6 to 12 years.

The form must be completed by teachers and parents.

• Vanderbilt Assessment - Parent

• Vanderbilt Assessment - Teacher

• Vanderbilt Follow-up Assessment - Parent

• Vanderbilt Follow-up Assessment - Teacher

• DSM-V Criteria

  To meet diagnostic criteria for ASD according to DSM-5, a child must have persistent deficits in each of three areas of social communication.

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• Travel and Early Release Med

  Please complete the form and email it to us at least one week before the date you require access to the medication or your planned travel date.

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• Medication Request Form

  Due to strict regulations surrounding stimulant and psychotropic medications, we are unable to accommodate emergency prescription requests. Please complete the form and email it to our team for review.

  This form is intended for:

  • Existing patients only
  • Prescription requests that cannot be issued during your appointment because the medication is not yet due for renewal
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• SNAP IV

  The SNAP-IV is a widely-used rating scale used to screen for Attention Deficit Hyperactivity Disorder. In its original form, the SNAP-IV had 90 items that evaluated hyperactivity-impulsiveness and inattention, as well as a variety of other psychiatric symptoms.

  The form must be completed by both teacher and parents.

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