Adolescent questionnaire pdf. This questionnaire was designed using resources from: Bright Futures 4th Edition, American Academy of Pediatrics Rapid Assessment for Adolescent Preventative Services (RAAPS), The Regents of the University of Michigan Seattle Children’s Hospital, Division of Adolescent Medicine, Confidential Adolescent Screen TEEN (Self-Report) Many families experience stressful life events. If you feel uncomfortable with any question you may leave it blank and we can discuss it when we meet. 05) INSTRUCTIONS: This questionnaire will help in understanding some problems that you may have. Adolescent please fill out pages 1-3, parent/guardian please fill out pages 4-7. 05) PATIENT HEALTH QUESTIONNAIRE FOR ADOLESCENTS (PHQ-A Version 3. Over time these experiences can affect your health and wellbeing. Please make sure to circle YES or NO for each question unless the instructions tell you to skip over some questions Adolescent and Young Adult Health Questionnaire (11-20 Years) Your name/What you like to be called: _________________ Pronouns: ____________________ PHQ-9 modified for Adolescents (PHQ-A) Name: Clinician: Date: In the past year have you felt depressed or sad most days, even if you felt okay sometimes? Yes No Confidential Adolescent Questionnaire Instructions: Please complete this questionnaire when your parents and others are out of the room; when complete, give it directly to the medical assistant or healthcare provider. PATIENT HEALTH QUESTIONNAIRE FOR ADOLESCENTS (PHQ-A VERSION 3. . We would like to ask you questions so we can help you be as healthy as possible. 6. This questionnaire will help me get to know a little more about your situation and how I may be of help to you. ykb sty dbjaiyvxf crh fiusij yzmh ttplfj yrswb nyvq yidjamy