Demo Site

Acquired Deficit and Awareness Management System

Survey For: ______________________

Robert Baker

(Key Pages)

Instructions:

Dear Doug Herrmann,

For each item in the following Survey, please indicate how often the person being assessed has exhibited the behavior identified in each of the following statements. Indicate your choice by clicking on the appropriate option.

In the example below, if over the past 30 days this person has exhibited difficulty in controlling his or her anger, then indicate how often this kind of event has occurred.

If he or she has occasionally exhibited difficulty controlling their anger, or only done so in certain situations, you would click on the response option “A Little” for this item.

If he or she blows up all the time, or has done so quite frequently over the past 30 days, you would click on the response option “A Lot” (“All The Time” or “Frequently” are also appropriate for this item).

On the other hand, if this person hasn’t had difficulty controlling their anger over the past 30 days, and such an event is highly unlikely, you would click on “Not At All.”

Use the same process for all other items in the Survey…there are a total of 36 items in this list. Please take your time and be as accurate as possible with your answers.

2. This person can’t control his or her anger.

They easily become upset even over little things. They have a hard time controlling their emotions. They often “go off” for little or no reason.

A Lot

All The Time

Frequently

A Little

Sometimes

Occasionally

Not At All

Unlikely

Never

Click on Begin when you are ready to start the Survey.

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