Mental Health Information
This brief form will let us know about any mental health concerns you have about your teen so that we can better work with them to support them. Please complete this form with your teen if possible, or have them complete it themselves.
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Participant's First and Last Name *
Has your teen been struggling with any of these symptoms?  *
Required
Has your teen experienced any of these significant events recently? *
Required
Does your teen have any health issues? If yes, please explain. *
Is your teen taking any medications? If yes, what kind? *
Has your teen ever had a serious accident/illness or hospitalization? If yes, please explain. *
Does your teen use any substances? If yes, which ones? *
Has your teen ever been seen by a counselor/therapist before? If yes, where and when? *
Has your teen ever experienced any of these symptoms or events?  *
Required
Has your teen ever been involved in any of these incidents? *
Required
How is your teen doing in school? *
Do you have any other concerns?
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