Screening Forms

If you are an existing patient who has been directed to this site to complete screening forms, please click on the appropriate form below. Print the form, complete and mail or fax back to my office.  

(You may choose to review or complete any form on the website that is of interest to you.)

If you cannot access a form or if you are unable to print a form, please contact my office at 845-679-0100.

1) Pediatric symptom checklist - pediatricsymptomchecklist_english

2) Pediatric symptom checklist youth informant (for youth 11 years old and above) - pediatricsymptomchecklist_english_Y.pdf

3) ADHD  Vanderbilt parent informant - ADHD Vanderbilt parent informant.pdf

4) ADHD Vanderbilt informante de padres - ADHD Vanderbilt informante de padres.pdf

5) ADHD Vanderbilt teacher informant - ADHD Vanderbilt teacher informant

6) Rating scale anxiety parent informant - ratingscaleanxietyScaredParent-final

7) Rating scale anxiety child informant (for children 8 years old and above; children 8-11 may need adult help understanding the questions) - ratingscaleanxietyScaredChild-final

8) Rating scale anxiety preschool child - scas-preschool-scale.pdf

9) Rating scale depression youth (for youth 13 years old and above) - ratingscaledepressionbeck_depress_inv

10) Rating scale mood parent informant - ratingscaleymrsparent.pdf

11) Rating scale mood parent informant – ratingscalecbcl

12) Rating scale autism M-CHAT - ratingscaleautismm-chat

13) Rating scale Asperger Syndrome Test - ratingscaleAspergerSyndromeTest.doc

14) SensoryProcessingDisorderChecklist.doc