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About Us
Important Things To Know
Our Clinical Team
Our Support Team
Mission Vision Values
Our Environment
Careers
Assessments
Adults
Children
Teens
Psychotherapy
Adults
Teens
Children
Workshops
New Clients
Our Promise to You
Quick 1st Appointment
Our Clinical Approach
What to Expect
Virtual Services
Fees + Coverage
FAQs
Resources
Videos
Articles
Infographics
Questionnaire
Contact
Mental Health Questionnaire For Teens
Answer each question, then click ‘next’ to continue.
Teen Mental Health Screening Questionnaire
0% Complete
1 of 12
8-18 -
Eating alone due to feelings of embarrassment about how you are eating
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
1-2 -
Unable to be productive at school/at home
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
4-17 -
Keeping yourself constantly distracted in order to prevent thinking about a traumatic/stressful event
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
2-8 -
Difficulty controlling your emotions
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
3-8 -
Difficulty breathing
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
2-24 -
Have unstable, unhealthy relationships
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
2-11 -
Irritable to the point that you yelled or started arguments with others without being provoked
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
3-14 -
Avoiding situations that cause anxiety/panic
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
5-14 -
Difficulties listening and understanding what is being said
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
2-9 -
Involvement in impulsive/risky behaviours that may have negative consequences (e.g., spending too much, binge drinking, substance abuse, binge eating, etc.)
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
3-2 -
Feeling on edge
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
5-2 -
Difficulties with procrastination
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
7-9 -
Feeling bad/guilty about your use of alcohol and/or substances
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
4-10 -
Flashbacks or nightmares as a result of being involved in or witness to a traumatic/stressful event (e.g., assault/violence, accident, fights, death)
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
8-2 -
Gained or lost weight recently
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
If you are human, leave this field blank.
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