Teacher Questionaire

I have a physician using a questionaire that the teacher fills out for ADHD patients. There are 28 questions that the parents answer with not at all, just a little, pretty much, very much. He then states whether it is consistent with ADHD but no other report done. He says it is a Connor's Test but based on what I can find that test has 3 parts to it. I'm not sure this form is enough to be able to bill for.

Any help would be greatly appreciated!!