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Online assessment

Let us find the right support for you

Takes about 5 minutes. You can stop and finish later.

This helps us understand what is going on and choose the right next step. Answer as honestly as you can, in your own time. A New Zealand clinician will review your answers, available results and records, and may ask your GP for more information with your consent. If online care is appropriate, we aim to contact you within 24 to 48 hours.

This is not an emergency service, and we cannot monitor this form in real time. If you need urgent help right now, free call or text 1737 any time to talk with a trained counsellor, or call 111 in an emergency.
First, a quick check
In the past 2 weeks, how often have you had thoughts that you would be better off not here, or of hurting yourself?
Thank you for telling us. If you are not safe right now, please free call or text 1737 any time, or call 111. You do not have to wait for us to reach out. Please still finish and send this form so we can prioritise you, and reach out to someone you trust.
Choose your booking path

Choose what fits best

You can change this later. Pick the closest option, then tell us more in your own words.

Whatever you choose, a New Zealand clinician reviews everything. There are no wrong answers.

1 About you and your aiga
2 What brings you here
3 Focus and attention right now

Over the past 6 months, how often have you experienced each of these? Choose the answer that fits best.

4 Attention and organisation

How often do these happen for you, as an adult? (If you are filling this in for a younger person, answer for them.)

5 Restlessness and impulsivity

How often do these happen for you?

6 When you were a child (before age 12)

ADHD starts in childhood, so this part matters. Answer as best you remember.

7 Where it affects your life

How much difficulty do focus, organisation or restlessness cause in each area?

8 Mood and worry

Over the past 2 weeks, how often have you been bothered by these?

9 Sleep, energy and substances
10 Your safety

We ask everyone this. It helps us keep you safe.

Thank you for telling us. If you are not safe right now, please free call or text 1737 any time, or call 111. You do not have to wait for us to reach out. You can still finish and send this form, and we will prioritise you.
11 Health and development
12 Your aiga's health
13 Your strengths
14 Your GP and consent

Your answers are private and used only to arrange and guide your care. How we protect your information.

1 About you and your aiga
2 What brings you here
3 How you have been feeling

Over the past 2 weeks, how often have you been bothered by these?

4 Your safety

We ask everyone this. It helps us keep you safe.

Thank you for telling us. If you are not safe right now, please free call or text 1737 any time, or call 111. You do not have to wait for us to reach out. You can still finish and send this form, and we will prioritise you.
5 Health and lifestyle
6 Your aiga's health
7 Your strengths
8 Your GP and consent

Your answers are private and used only to arrange and guide your care. How we protect your information.

Malo, thank you for trusting us with this.

Your questionnaire is on its way to our clinical team for review. We aim to be in touch within 24 to 48 hours to confirm whether telehealth support is right for you. If online care fits, we send a secure payment link, book your consult, then provide a plan and outcome. We are not able to monitor this form in real time or after hours, so if anything feels urgent before then, free call or text 1737 any time, or call 111 in an emergency.

That did not send

Something stopped your questionnaire from sending, so we have not received it yet. Please email admin@pasifikarise.co.nz to let us know, or press “Try again”. If anything feels urgent, free call or text 1737 any time, or call 111 in an emergency.