HBimed Questionnaire Report Submission

Provide the completed HBimed questionnaires and a report is provided to you within 5 business days.

Product: $50

Credit Card Processing Fees: $1.75





  1. Make a payment
  2. Contact [email protected] to set up dropbox.
  3. Submit completed questionnaires for report to Dropbox
  4. Please include the client's birthdate on each form under “Age”
  5. Completed questionnaires must be submitted in excel format and fully completed, not missing any check boxes.  Incomplete data will incur a $25 administrative fee.


As part of the Sadar evaluation process we routinely have clients/patients complete four questionnaires.

  1. Personal and Clinical Data- This allows patients to report in narrative form relevant information about their past and present functioning (e.g., issues around their birth, school, drugs/alcohol, sleep, etc.). This becomes a part of the generated report and serves to present clinical and historical information as a part of the report.
  2. Symptoms and Cortical Networks Questionnaire (developed by Dr. Amen)- the client/patient indicates frequency of experience of numerous items (e.g., difficulties concentrating; periods of heart pounding; etc.). Their pattern of responses is then correlated with possible stress/strain in five brain regions (basal ganglia, cingulate cortex, temporal lobes, prefrontal cortex and limbic system). 
  3. van Deusen Questionnaire (developed by Peter van Deusen)- similar to the Amen questionnaire but the results are presented in a more geographical way depicting which cortical region (e.g., prefrontal, sensory motor, parietal, etc.) appear to be affected based on the client/patient’s pattern of responses. 
  4. ADHD Questionnaire- this assesses for inattentiveness, hyperactivity/impulsiveness, over focusing and issues with emotional regulation.

You can download copies of the questionnaires for analysis below.