Forms
For some referral problems, it is very helpful to have additional information. Please complete the forms requested and drop them off at our office or fax (250-591-1913) before your appointment if possible. Most questionnaires are used for screening purposes only and may help us to rule in or rule out certain conditions.
If your child is school age, also bring report cards to the appointment.
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PARENT GENERAL QUESTIONNAIRE
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CADDRA TEACHER Assessment Form
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SNAP IV-26 (PARENT AND TEACHER)
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ADHD PRESCHOOL RATING SCALE
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SCHOOL AGE Weiss Symptom Record(WSR)-PARENT and/or TEACHER
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ADHD Weiss Functional Impairment scale(WFIRS-PARENT)
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ADHD Vanderbilt ASSESSMENT Q-PARENT
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ADHD Vanderbilt ASSESSMENT Q-TEACHER
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ADHD Vanderbilt FOLLOW UP Q-PARENT
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ADHD Vanderbilt FOLLOW UP Q-TEACHER
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M-CHAT AUTISM SCREEN
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AUTISM SCREEN for >6
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AUTISM SCREEN for <6YR
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ANXIETY SCARED Q-CHILD
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ANXIETY SCARED Q-PARENT
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TEEN Kutcher social anxiety scale (GSADS)
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TEEN DEPRESSION SCREEN (KADS 6)
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TEEN FUNCTIONAL ASSESSMENT (TeFA)
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DEVELOPMENTAL COORDINATION DISORDER Q