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Child/Adolescent Psychiatric Screen (CAPS)

For each item below, check the one category that best describes your child during the past 6 months.

None = the child never or very rarely exhibits this behavior. Mild = the child exhibits this behavior approximately once per week, and few others notice or complain about this behavior. Moderate = the child exhibits this behavior at least three times per week, and others notice or comment on this behavior. Severe = the child exhibits this behavior almost daily, and multiple others complain about this behavior. Past = the child used to have significant problems with this behavior, but not during the past 6 months.

Personal Information
Date
Date
Enter today's date/date form is submitted
Child's Name *
Child's Name
Date of Birth
Date of Birth
Screening