Clinic Forms

You will usually be asked to fill out some forms to provide information about concerns, medical history and family information. If your child is in school, there are some forms for the teacher to fill out as well.

These forms are tools the paediatricians use to gain a broader picture of your child’s health. Please complete the forms requested of you and send in prior to your appointment by fax, e-mail or drop off at our office.

Please complete only the paperwork requested of you by our clinic.

Forms for Parents

Parent Questionnaire
Modified Checklist for Autism in Toddlers (M-CHAT)
The Childhood Autism Spectrum Test (CAST)
Weiss Functional Impairment Rating Scale – Parent Report (WFIRS-P)

Forms for Teachers

Preschool / Kindergarten questionnaire
School questionnaire (6-18 Years)
Teacher Assessment Form

Other Forms

Screen for Child Anxiety Related Disorders (SCARED) – Parent Version
Screen for Child Anxiety Related Disorders (SCARED) – Child Version
Patient Health Questionnaire (PHQ-9)
Children’s Yale-Brown Obsessive Compulsive Scale Symptom Checklist (CY-BOCS)
ADHD rating scale for parents and teachers (SNAP-IV-26)