Screening Quiz #2

Vanderbilt Screening for Parents

Instruction: Each rating should be considered in the context of what is appropriate for the age of your child. When completing this form, please think about your child’s behaviors in the past 6 months.

Please use the same email in your original booking.
Please use the same phone number in your original booking.

Symptoms

Never = 0 | Occasionally = 1 | Often = 2 | Very Often = 3

Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often

Performance

Excellent = 1 | Above Average = 2 | Average = 3 | Somewhat of a Problem = 4 | Problematic = 5

Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
Never Very often
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