Skip to main content
K. Johns MedicalMedical & Behavioral Health

Screening · About 4 minutes

Pediatric behavioral and emotional screening

For children age 5 and older. A parent or guardian should complete this about their child, based on the past two months.

About you

Please give at least a telephone number or an email address so the office can reach you.

About the child
In the past two months, my child…
Seems sad or unhappy*
Worries a lot or is very anxious*
Is irritable or angry*
Has trouble concentrating or is easily distracted*
Fidgets, is restless, or cannot sit still*
Does not listen to rules or argues with adults*
Has difficulty making or keeping friends*
Is teased or bullied by other children*
Has trouble sleeping*
Has physical complaints such as headaches or stomachaches without a clear cause*
Has said things that made you worry about self-harm*
Has had a noticeable drop in school performance*
Context
May we request input from your child's teacher, with your written authorization?

Your responses are scored automatically when you submit. A score is not a diagnosis and is always reviewed by a clinician.

Submitting sends your answers directly to K. Johns Medical over an encrypted connection and creates a PDF for your clinician. It does not book an appointment and is not monitored in real time. For an urgent concern, call the office. In an emergency, call 911 or call or text 988.

Other screenings