AUBREY K. EWING PH.D. & ASSOCIATES, P.A.
1230 So. Federal Hwy, Boynton Beach, FL 33435
CHILD & ADOLESCENT CLINICAL QUESTIONNAIRE FOR PARENTS
The Child & Adolescent Clinical Questionnaire is intended to be completed by parents of children and adolescents for whom you are seeking counseling or other psychological services. It asks you to provide information about why you are making an appointment for your child, her/his general emotional and physical health, pertinent history, and what about your child is of greatest concern to you. The questionnaire helps your doctor/therapist get a head-start on the evaluation and treatment planning process.
This information will become part of your child's confidential record with this office and will not be released to anyone without your written permission. Your answers to these questions are considered protected health information (PHI) and are relayed to our office by a secure, HIPAA compliant process. We are committed to ensuring your child's privacy and protecting our confidential relationship.