Child Assessment

14 Question Assessment:
Is The Journey Right for Your Teen?

All information submitted is confidential.
Results will be displayed upon pressing the "Submit Assessment" button.

Please answer Yes or No to each question

1. Have you noticed changes in the past few months regarding your teen's motivation, school grades, mood swings, or overall behavior? (eg. withdrawn, angry, sad)
	Yes	No
2. Does you teen have any special learning needs? (eg. ADHD, ADD, Learning Disabilities, Specific Learning Style)
	Yes	No
3. Does your teen have problems which might be a result of a traumatic event in his/her life? (divorce, adoption, abuse, death, etc.)
	Yes	No
4. Do you suspect your teen of using alcohol or drugs?
	Yes	No
5. Is your teen resistant to or refusing to follow family rules or your parenting?
	Yes	No
6. Does your teen seem depressed or withdrawn?
	Yes	No
7. Is your teen showing problems controlling his/her anger, or has he/she been destructive to property?
	Yes	No
8. Is your teen struggling in school with lack of motivation, truancy, fighting, or other poor behavior?
	Yes	No
9. Have you reason to suspect that your teen has been stealing from you or others?
	Yes	No
10. Does your teen seem to be able to avoid consequences by manipulating people or situations, while blaming other for his/her difficulties?
	Yes	No
11. Has you teen left your home without your permission, or stayed away longer than a couple of hours without your knowing where he/she was? Or has your teen told you he/she was going one place, and you found out later he/she was somewhere that you would not have approved of?
	Yes	No
12. Have you ever been concerned that your teen might be thinking about committing suicide?
	Yes	No
13. Has your teen exhibited symptoms of an eating disorder?
	Yes	No
14. Has your teen's behavior ever resulted in any involvement with the police or the courts?
	Yes	No

Contact Information

Your Name:
Your Phone Number:
Your Email Address:

Need Help with your Teenager?

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Child Assessment

619 North 500 West
Provo, UT 84601

Chris Allen 801-885-0559
chris@journeywilderness.com

Child Assessment

14 Question Assessment: Is The Journey Right for Your Teen?

14 Question Assessment:
Is The Journey Right for Your Teen?