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Home
About
Services
Applied Behavior Analysis
Evaluations
Online Therapy
Resources
E-Learning
Blog
Insurances
SCREEN YOUR CHILD
REFER A CLIENT
CONTACT US
Get Help
305 827 2822
CHILDREN SCREENING
Home
About
Services
Applied Behavior Analysis
Evaluations
Online Therapy
Resources
E-Learning
Blog
Insurances
SCREEN YOUR CHILD
REFER A CLIENT
CONTACT US
CHILDREN SCREENING
Please enable JavaScript in your browser to complete this form.
Parent Name
*
First
Last
Child Name
*
First
Last
Phone
Child's age
*
Email
*
Feels sad, unhappy
*
Never
Sometime
Often
Feels hopeless
*
Never
Sometime
Often
Is down on self
*
Never
Sometime
Often
Worries a lot
*
Never
Sometime
Often
Seems to be having less fun
*
Never
Sometime
Often
Fidgety, unable to sit still
*
Never
Sometime
Often
Daydreams too much
*
Never
Sometime
Often
Distracted easily
*
Never
Sometime
Often
Has trouble concentrating
*
Never
Sometime
Often
Acts as if driven by a motor
*
Never
Sometime
Often
Fights with other children
*
Never
Sometime
Often
Does not listen to rules
*
Never
Sometime
Often
Does not understand other people’s feelings
*
Never
Sometime
Often
Teases others
*
Never
Sometime
Often
Blames others for his/her troubles
*
Never
Sometime
Often
Refuses to share
*
Never
Sometime
Often
Takes things that do not belong to him/her
*
Never
Sometime
Often
Please note: Online screening tools are not diagnostic instruments. You are encouraged to share your results with your child’s physician or healthcare provider.
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