Anxiety/Depression Child's Name(Required) First Last Parent/Caregiver's Name(Required) First Last Describe symptoms.(Required)Duration of symptoms.(Required)Are you experiencing difficulties at home or school?(Required) Yes No Describe in detail.(Required)Have you tried any previous treatments?(Required) Yes No Describe in detail.(Required)Are you currently following with any mental health providers?(Required) Yes No Please list in detail.(Required)CAPTCHA
