Get Pediatric Symptom Checklist

The Pediatric Symptom Checklist is a vital tool designed to assess the emotional and behavioral health of youth. Completing this form online helps identify potential issues, ensuring timely support for children who may need it.

Follow the steps to effectively complete the checklist online.

1. Press the ‘Get Form’ button to retrieve the checklist and access it in your preferred digital format.
2. Begin by entering the date at the top of the form. This helps in keeping track of when the assessment was completed.
3. Provide the child's name and date of birth in the designated fields. Ensure that the information is accurate, as it is essential for proper follow-up.
4. In the checklist section, you will see a series of statements that describe various behaviors and feelings. For each statement, select one of the options: 'Never,' 'Sometimes,' or 'Often' to indicate how frequently the child experiences each symptom.
5. After completing the checklist, you will find a section asking if you have any concerns that you would like to address. Indicate 'Yes' or 'No.' If 'Yes,' provide details in the space provided.
6. Fill out the additional information regarding the child's school, grade, and homeroom teacher. This ensures the assessment is connected to the child's educational background.
7. Proceed to the consent section. If you agree for your child to participate, print your name, provide your signature, and the date.
8. Finally, review all filled sections for accuracy. Once confirmed, you can save your changes, download the form, or print it for submission.

Complete the Pediatric Symptom Checklist online to support your child's emotional health today.