Specializing In

Angry & Defiant
Failing in School
Rebellious
Impulsive
Running Away
Substance Abuse
Low self-esteem
Overconfident
Negative Peer Group
Distant from Family and Friends
Laziness
Underachieving
ADD/ADHD
Hyperactivity
Bi-Polar
Sexually Acting Out
Manipulation
Depression
Weight Problems
Learning Difficulties

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Teen Questionnaire
Teen Questionnaire
  1. Does your troubled teen fail to complete tasks that require effort regardless of the future importance of the task? (e.g. school work)
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  2. Does your troubled teen attempt to negotiate and/or manipulate in order to avoid consequences and problems?
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  3. Does your troubled teen justify negative behaviors by blaming others?
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  4. Is your troubled teen unwilling to recognize the impact of his/her behavior on family and friends?
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  5. Does your troubled teen use manipulation and deception in order to change others' points of view?
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  6.  
  1. Does your troubled teen have weekly outbursts or mood swings?
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  2. Does your troubled teen avoid participating in family activities and social events?
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  3. Does your troubled teen become impatient or easily agitated with others?
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  4. Does your teen have an intense fear of gaining weight or becoming fat?
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  5. Has there been a recent drop in your teen's performance at school?
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  6. Is it difficult for your teen to relate with others or make friends?
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  7. Does your teen frequently fail to finish schoolwork, projects or chores?
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  8. Does your teen fail to follow through with responsibilities or instructions?
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  9. Is your teen forgetful or often viewed as lazy?
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  10. Does your teen argue with adults and authority figures?
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  11.  
  1. Is your teen failing one or more courses in school?
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  2. Has your teen undergone therapy and/or counseling without results?
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  3. Does your teen do dangerous things without considering the consequences, "a daredevil?"
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  4. Has your teen been physically abusive to animals?
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  5. Is your teen extremely self-conscious?
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  6. Does your teen appear depressed, sad, tearful or irritable nearly every day?
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  7. Has your teen run away from home? (More than twice)
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  8. Is your teen sexually active?
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  9. Does your teen engage in self-injurious behaviors and/or threaten to inflict self-harm?
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  10. Does your teen use illegal drugs and/or alcohol?
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  11.  
  1. Parent's First Name*
    Please type your full name.
  2. Parent's Last Name
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  3. Street Address
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  4. Address Line 2
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  5. City
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  6. State
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  7. Zip / Postal Code
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  8. Country
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  9. E-mail*
    Invalid email address.
  10. Child's First Name
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  11. Child's Last Name
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  12. Child's Age
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  13. Child's Gender
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  14. Looking at child enrolling
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  15. How did you hear about us?
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  16. Referred By
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  17. Any further comments
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  18. Captcha
    Captcha
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  19.   

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