Forms to fill out to help the doctor with your care before your first visit and during your treatment.
Filling out questionnaires that apply to your child's situation before your visit, and during care, allows for greater depth and time to go into detail in the office. We highly recommend utilizing this resource. (please disregard instructions for clinicians and do not attempt to score at home, just answer the numbered questions and bring them to your office visit).
Autism or Intellectual Disability
Autism Screening / Infants with Social Difficulties
*You may choose one or both developmental websites to help assess your child's developmental level
*Developmental milestones for your child. Print out and bring to your visit to help assess your child's developmental stage.
*This website from the American Academy of Pediatrics provides useful developmental milestone information along with a variety of age relevant health topics for parents. Useful to review development milestones for your child and bring the paper to your first visit.
Level of Disability, Caregiver Report
*This questionnaire helps determine the effect of the disorder on the Child or adolescent's functioning.
© World health organization, 2012. Measuring health and disability: Manual for WHO disability assessment schedule (WHODAS 2.0), World health organization, 2010, Geneva.
Menstrual Cycle Related Mental Health Concerns (Females)
Physical or Verbal Aggression
Poor Focus and Hyperactivity
ADHD Screening Questionnaire for Parents and Teachers Long Version for Children Ages 6–18
*For First Assessment (teacher fills out one, parent fills out one)
ADHD Screening Questionnaire for Parents and Teachers Short Version for Children Ages 6–18
*For Following Symptoms During Treatment (teacher fills out one, parent fills out one)
Psychiatric Medication Response and Side Effect Monitoring Forms
Repetitive Obsessive Thoughts and Compulsive Routine Behaviors
Repetitive Obsessive Thoughts and Compulsive Routine Behaviors Questionnaire
*Parent/Child to Fill Out Ages 6-14
Two-week sleep diary
*This sleep diary will help identify issues related to sleep and track improvements over time.
*All forms listed above are provided as a courtesy for our patients. Mental Fitness Clinic is not responsible for any material provided by websites other than www.mentalfitnesclinic.com.