PEERS® Initial Questionnaire

Please complete this initial questionnaire so we have a better understanding of your teen/young adult prior to our call. All information will remain in the strictest confidence.

Parent / Contact Name *

Parent / Contact Email *

Parent / Contact Phone Number *

Postal Code

Participant Name *

Participant Age *

Participant Gender and Preferred Pronouns

School/Grade or Uni/Work (if applicable)

Please let us know which school you go to, or where you work if you are working.

Diagnosis (if any)

What else would you like us to know about your young person?

I consent to receive transactional messages related to my account or services I have requested.