Parent Questionnaire

Helping your young person requires us to understand what they’re going through.  This questionnaire helps us formulate with you an understanding of why your child is having their difficulties in this way at this time.  Try and be as descriptive as possible.  We will learn about them more at your assessment.

Your information will be kept only for the purposes of the assessment and stored in your child’s clinical record.  Information sharing with other clinical providers can occur with your consent. Please refer to the consent and financial agreement document provided to you or our privacy policy for more information.

Please tick the concerns you have about your child:
Please describe how the issues impact your child’s life:
Please tell us about the impact of your child’s difficulties on their relationships.
Help us understand the background of your child’s difficulties.

About The Family
About your child's early life
Please indicate if any of the following concerns were experienced by your child at school or in their earlier years:
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