Child and Family Interview Form – School

Child & Youth Mental Health General Screening Questionnaire

Completed by School Referral

This information will assist us in providing the best possible care for this student and their family. Your answers will be kept as part of the child’s or teen’s clinical record which they have the right to request in future.

Please know that answering these questions is completely voluntary and will not affect the services the young person may receive from Salt Spring Island Community Services. We invite you, however, to be as forthright as you can be to help us to determine how best to support this student. There may be questions you cannot answer due to limited information –  this is not a concern.

The form is in six parts and must be completed in one session before submission so please allow yourself ample time – approximately 10 or 15 minutes.

Step 1 of 6