Assessment Forms and Questionnaires:

Please complete any of the following questionnaires that may apply to your situation.  While optional, these assessment forms provide us with a quick "snapshot" that allows for further inquiry.  If unsure which forms to complete, please contact us for guidance.

 

NOTE: the following tests can only be scored and interpreted by a mental health professional with expertise in psychological testing and with the scoring instructions that accompany each test.  Do not use as a "self-assessment."

Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.

Adult Symptom Checklist:

This measure consists of 23 questions that assess 13 psychiatric domains, including depression, anger, mania, anxiety, somatic symptoms, suicidal ideation, psychosis, sleep problems, memory, repetitive thoughts and behaviors, dissociation, personality functioning, and substance use. Each item inquires about how much (or how often) the individual has been bothered by the specific symptom during the past 2 weeks.
Adult Symptom Checklist.pdf
Adobe Acrobat document [39.7 KB]

Child Symptom Checklist - Age 6-17 (rated by the parent):

This measure consists of 25 questions that assess 12 psychiatric domains, including depression, anger, irritability, mania, anxiety, somatic symptoms, inattention, suicidal ideation/attempt, psychosis, sleep disturbance, repetitive thoughts and behaviors, and substance use. Each item asks the parent or guardian to rate how much (or how often) his or her child has been bothered by the specific symptom during the past 2 weeks.
Child Symptom Checklist_age 6_17.pdf
Adobe Acrobat document [41.1 KB]

Child Symptom Checklist - Age 11-17 (rated by the child):

This child-rated measure consists of 25 questions that assess 12 psychiatric domains, including depression, anger, irritability, mania, anxiety, somatic symptoms, inattention, suicidal ideation/attempt, psychosis, sleep disturbance, repetitive thoughts and behaviors, and substance use. Each item asks the child, age 11–17, to rate how much (or how often) he or she has been bothered by the specific symptom during the past 2 weeks.
Child Symptom Checklist_age 11_17.pdf
Adobe Acrobat document [42.8 KB]

Child ADHD Symptom Checklist:

This checklist describes the types of symptoms that a healthcare provider will ask about in the process of deciding whether a child has ADHD. You can use this checklist to help you start the conversation.
ADHD-symptom-checklist.pdf
Adobe Acrobat document [581.3 KB]

Adult ADHD Self-Report Scale:

Research suggests that the symptoms of ADHD can persist into adulthood, having a significant impact on the relationships, careers, and even the personal safety of your patients who may suffer from it.1-4 Because this disorder is often misunderstood, many people who have it do not receive appropriate treatment and, as a result, may never reach their full potential. Part of the problem is that it can be difficult to diagnose, particularly in adults.
Adult ADHD Self Report Scale.pdf
Adobe Acrobat document [15.9 KB]

Childhood Autism Spectrum Test:

This questionnaire was developed by ARC (the Autism Research Centre) at the University of Cambridge, for assessing the severity of autism spectrum symptoms in children.
The Childhood Autism Spectrum Test.pdf
Adobe Acrobat document [323.4 KB]
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