Surveys and Questionnaires

A checklist to evaluate toddlers at the 18 or 24 month Well Child Check.

• Download Form

The Guidelines for Adolescent Preventive Services (GAPS) Questionnaire is a comprehensive screening tool designed to address the special needs of adolescents.

• Parent/Guardian Questionnaire
• Younger Adolescent Questionnaire (Ages 11-14)
• Middle-Older Adolescent Questionnaire (Ages 15-21)

A test used to help assess attention deficit/hyperactivity disorder (ADHD) and evaluate problem behavior in children and adolescents.

• Download Parent Version

A test used in the diagnosis and evaluation of children with ADHD.

• Parent Version
• Teacher Version
• Parent Follow Up
• Teacher Follow Up

A health questionnaire to evaluate adolescents. Please bring your completed survey with you to your visit with your pediatrician.

• Adolescent Health Evaluation
• Sports Physical Forms

Health questionnaires and resources to help manage the weight of children and adolescents.

• Weight Management Questionnaire Twelve years old and younger.
• Weight Management Questionnaire Thirteen years and older.
• Track it
• Healthy Habits Book
• Habit Builder
• Prescription for Kids, Teens and Families

In an emergency, you rarely have the time to stop and look up a number. An emergency contact sheet is a great way of making sure you have all the information you need right in front of you. Just download the PDF, print it, fill it out, and stick a copy by the phone and in your car. And be sure your children and anybody watching your children know where it is.

• Emergency Contact Sheet

Una prueba utilizados en el diagnóstico y la evaluación de los niños con TDAH.

• Cuestionario para Padres
• Cuestionario del Maestro

The Guidelines for Adolescent Preventive Services (GAPS) Questionnaire es una herramienta de cribado integral diseñada para abordar las necesidades especiales de los adolescentes.

• Cuestionario Para Padres o Guardianes
• Cuestionario Para Adolescentes Jóvenes (Ages 11-14)
• Cuestionario Mayores Para Adolescentes (Ages 15-21)

Una lista de comprobación para evaluar a los niños pequeños en la revisión del niño sano de 18 o 24 meses.

• Cuestionario M-CHAT

A survey to measure depression in children and adolescents ages 11-17.

• Severity Measure for Depression - Child Age 11-17

A survey to evaluate mood and motivation.

• The Patient Health Questionnaire – 2

Questions for children to address anxiety levels.

• Screen for Child Anxiety (SCARED) - CHILD Version

Questions for parents in regards to their child's anxiety level.

• Screen for Child Anxiety (SCARED) - PARENT Version

This test will provide a score that may help your doctor determine if an asthma treatment plan is working or if it might be time for a change.

• ACT (Asthma Control Test) Ages 4 – 11
• ACT (Asthma Control Test) Ages 12 and older

Survey of Well-being of Young Children

• SWYC 2 Months
• SWYC 4 Months
• SWYC 6 Months
• SWYC 9 Months
• SWYC 12 Months
• SWYC 15 Months
• SWYC 18 Months
• SWYC 24 Months
• SWYC 30 Months
• SWYC 36 Months
• SWYC 48 Months
• SWYC 60 Months

Encuesta sobre el bienestar de los niños pequeños

• SWYC 2 Meses
• SWYC 4 Meses
• SWYC 6 Meses
• SWYC 9 Meses
• SWYC 12 Meses
• SWYC 15 Meses
• SWYC 18 Meses
• SWYC 24 Meses
• SWYC 30 Meses
• SWYC 36 Meses
• SWYC 48 Meses
• SWYC 60 Meses