Child information

Emotional and physical health go together in children. Because parents are often the first to notice a problem with their child's behavior, emotions, or learning, you may help your child get the best care possible by completing this screening.

Behavioral checklist

Please indicate which statement best describes your child. For each item, select Never, Sometimes, or Often based on your child's behavior over the past month.

This is a screening tool only and is not meant to be used as a diagnosis. Dr. Marie will review your responses and discuss next steps with you if needed.

Review & submit

Please review your information below before submitting. Once submitted, your responses will be securely encrypted and available only to Dr. Marie.