Adult Mind Questionnaire 940 E. El Camino Real Sunnyvale, CA 94087 harminder@homeopathicvibes.com www.homeopathicvibes.com Office Phone (408)737-7100 Office Fax (408)737-7102 Name *FirstLastEmail *Phone *1. At home, work, or school, I find my mind wandering from tasks that are uninteresting or difficult.Not at all Just a little Somewhat Moderately Quite a lot Very much 2. I find it difficult to read written material unless it is very interesting or very easy.Not at all Just a little Somewhat Moderately Quite a lot Very much 3. Especially in groups, I find it hard to stay focused on what is being said in conversations.Not at all Just a little Somewhat Moderately Quite a lot Very much 4. I have a quick temper... a short fuse.Not at all Just a little Somewhat Moderately Quite a lot Very much 5. I am irritable, and get upset by minor annoyances.Not at all Just a little Somewhat Moderately Quite a lot Very much 6. I say things without thinking, and later regret having said them.Not at all Just a little Somewhat Moderately Quite a lot Very much 7. I make quick decisions without thinking enough about their possible bad results.Not at all Just a little Somewhat Moderately Quite a lot Very much 8. My relationships with people are made difficult by my tendency to talk first and think later. Not at all Just a little Somewhat Moderately Quite a lot Very much 9. My moods have highs and lows.Not at all Just a little Somewhat Moderately Quite a lot Very much 10. I have trouble planning in what order to do a series of tasks or activities.Not at all Just a little Somewhat Moderately Quite a lot Very much 11. I easily become upset. Not at all Just a little Somewhat Moderately Quite a lot Very much 12. I seem to be thin skinned and many things upset me.Not at all Just a little Somewhat Moderately Quite a lot Very much 13. I almost always am on the go.Not at all Just a little Somewhat Moderately Quite a lot Very much 14. I am more comfortable when moving than when sitting still.Not at all Just a little Somewhat Moderately Quite a lot Very much 15. In conversations, I start to answer questions before the questions have been fully asked?Not at all Just a little Somewhat Moderately Quite a lot Very much 16. I usually work on more than one project at a time, and fail to finish many of them.Not at all Just a little Somewhat Moderately Quite a lot Very much 17. There is a lot of “static” or “chatter” in my head.Not at all Just a little Somewhat Moderately Quite a lot Very much 18. Even when sitting quietly, I am usually moving my hands or feet.Not at all Just a little Somewhat Moderately Quite a lot Very much 19. In group activities it is hard for me to wait my turn. Not at all Just a little Somewhat Moderately Quite a lot Very much 20. My mind gets so cluttered that it is hard for it to function. Not at all Just a little Somewhat Moderately Quite a lot Very much 21. My thoughts bounce around as if my mind is a pinball machine. Not at all Just a little Somewhat Moderately Quite a lot Very much 22. My brain feels as if it is a television set with all the channels going at once.Not at all Just a little Somewhat Moderately Quite a lot Very much 23. I am unable to stop daydreaming.Not at all Just a little Somewhat Moderately Quite a lot Very much 24. I am distressed by the disorganized way my brain works.Not at all Just a little Somewhat Moderately Quite a lot Very much MessageSubmit