• Pediatric Symptom Checklist (PSC-35)

    Provided by: Wellness Grove
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year

  • PSC-35

  • Emotional and physical health go together in children. Because parents are often the first to notice a problem with their child’s behavior, emotions, or learning, you may help your child get the best care possible by answering these questions. Please indicate which statement best describes your child.

  • General Feedback*
    Rows
  • Attention*
    Rows
  • Internalizing*
    Rows
  • Externalizing*
    Rows

  • Acknowledge & Sign
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: