S E I K Psychiatry

Screening Questionnaire - CAMHS

This questionnaire will help you identify whether an assessment with S E I K Psychiatry is suitable for your child.

Please complete this form with as much detail as possible, as the information will also be used for your assessment if you decide to use our services.

One of our Onboarding staff will contact you within a few days of receiving your response to discuss your next steps.

Email Address *

Contact number *

Please enter your full name *

Please enter the patients full name *

Please enter the patients date of birth *

Please state your relationship to the patient *

Type of Assessment *

Has the patient ever had an ADHD and/or ASD assessment before? If so, please provide details *

If you answered "yes", please provide any details (i.e. when and what was the outcome) *

Please describe the main issues causing you concern *