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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 Parents/Guardians of Children
Answer each question, then click ‘next’ to continue.
Child Mental Health Screening Questionnaire
0% Complete
1 of 12
6-11 -
Seeing a shadow in their peripheral vision
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
4-8 -
Avoiding reminders of a previously upsetting or stressful experience
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
6-5 -
Feeling as if someone is trying to influence their thoughts/behaviour
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
4-1 -
Feeling more jumpy than normal
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
5-3 -
Difficulties with organization
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
1-7 -
Feeling tired all of the time (i.e., even simple tasks require substantial effort)
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
2-1 -
Do not require sleep for several days
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
7-12 -
Had problems at home or school as a result of their alcohol or substance use
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
8-12 -
Eating when sad/angry/stressed
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
2-19 -
Unable to recognize current emotions
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
7-11 -
Tried to stop vaping, but failed
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
4-5 -
Expecting the worst from others/the world
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
5-11 -
Unable to follow multi-step instructions
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
3-12 -
Nausea or stomach aches unrelated to a known physical health issue
*
Not at all / Never
A little bit / Slightly
Somewhat / Moderate
Quite a bit / Often
Extremely
1-9 -
Difficulty making decisions
*
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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