Please complete and submit this form in order to receive TeenScreen Primary Care’s Screening Questionnaire Starter Kit that includes screening questionnaires for implementing mental health checkups in your practice. The (*) symbol denotes fields that are required.

Please note, these materials are designed for screening in primary care, medical and mental health settings only. If you are interested in screening in school or community-based locations, please click here.

*These materials are designed to be used by medical professionals and should only be used when access to professional care is in place.