What Child Problem/s Worries You? ________________________________________
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How would you rate this problem on a scale of 1 to 10, with 10 being the most serious?_______
How long has this problem been of concern? __________________________________
What do you think contributes to it?__________________________________________
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What have you done to solve the problem and how successful have your strategies been
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Do you wonder if this problem is serious or something the child will outgrow? ______________
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Where do you need help and what kind of support do you feel you need?___________________
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Do you think you and/or your child could benefit from the expertise of a child psychologist? And if so why? ______________________________________________________________________________
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