Stephen J. Harris, Ph.D., Logo
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Helpful Forms

Child Intake Packet

I am looking forward to working with you and your childr(ren). To aid my work with your family I am asking you to fill out the following forms. Please fill out the Child Intake Packet and Child Symptom Checklist for your child.

If your child is struggling in school in any way I have included an additional packet to be completed by your child's teacher which is called the Teacher Packet.

If you have any concerns about your child's ability to stay focused on tasks, control his/her impulses or control his/her activity level, please fill out the ADHD Packet.

Thank you for your willingness to give me this helpful information. Click on the blue link that you desire and you will be able to download the correct form which you can complete and bring to my office. To print the form once you are in Microsoft Word, after you click on the blue link, go up to the left hand corner of the screen, pull down the file menu and click on print.

Click on Link for Child and Adolescent Packet (which includes Symptom Checklist)

Click here for Child and Adolescent Symptom Checklist

• Click here for Teacher Packet

• Click on Link for ADHD Checklist