Emotional Wellness Screener

In the event of an emotional crisis and/or a physical emergency, please contact 911 as soon as possible to receive immediate assistance.

The Pediatric Symptom Checklist is a psychosocial screener made to help identify and assess changes in cognitive, emotional, or behavioral habits so that interventions can be provided as soon as possible to help your student. While this is not a diagnostic tool, it may help us by gaining a better understanding of what your child is experiencing, which will allow us to provide support to meet their needs.

Solicitud para hablar con traductor en español بحاجة لمترجم عربي

By completing this form, you are giving your permission for this information to be shared with your student's building social worker or counselor, who will then make contact to discuss potential next steps for support as soon as possible. Please see the linked forms below if you prefer to complete this form and discuss any concerns with another agency, such your student's pediatrician or therapist.

Pediatric Symptom Checklist in Arabic

Pediatric Symptom Checklist in English

Pediatric Symptom Checklist in Spanish