How Our Mental Health Questionnaire Can Help

Are you interested in learning more about your child’s mental health status? Take our brief questionnaire!

Please note: This questionnaire is a brief screening tool developed by mental health professionals at Sullivan + Associates Clinical Psychology. It is not intended for diagnostic purposes or to replace a formal mental health assessment. However, feel free to use it for personal interest and/or as a starting point towards improving your mental health and wellbeing. You may also want to share this information with the health professionals in your circle of care if you are concerned about your mental health.

Benefits of Taking our Mental Health Questionnaire

  • Easy to Do – It’s a rating scale style questionnaire. Just click on the selection that best describes you.
  • Confidential – Your responses and results are 100% confidential.
  • Direction – Suggests helpful next steps, such as suggestions for resources and services based on your responses.
  • Cost Effective – It’s free to use as many times as you want.
  • Quick to Use – It takes approximately 5-10 minutes to complete the test.
  • Immediate Results – You will receive your results immediately upon completing the test.
  • Free Report – If you enter your email address, you will receive a copy of your results. If you chose to provide your email address, your responses and results will remain 100% confidential.
  • Anonymous – You don’t need to provide any identifying information to complete the test.

Child Separation Anxiety Disorder Questionnaire

Answer each question, then click submit to see your results.

Child Separation Anxiety Disorder Mini-Questionnaire : Parents/Guardians
Gets anxious when they can't see me
Refuses to sleep in their own bed/alone
Gets extremely homesick
Cannot be left alone with a babysitter
Worries about being away from me
Throws a tantrum when I leave the house without them
Gets physically sick when away from me
Afraid of being left alone
Has nightmares about something bad happening to me
Will not spend time with friends unless I am there
Avoids activities where the parents leave
Gets very anxious when away from me
Wants to go everywhere with me
Worries about what will happen to me when I am not there
Refuses to leave me to go to school