{"id":10388,"date":"2023-09-07T11:08:59","date_gmt":"2023-09-07T18:08:59","guid":{"rendered":"https:\/\/samhealth.org\/?page_id=10388"},"modified":"2025-02-18T13:44:43","modified_gmt":"2025-02-18T21:44:43","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/samhealth.org\/health-services\/all-services\/mental-health-behavioral-health\/patient-forms\/","title":{"rendered":"Patient Forms"},"content":{"rendered":"\n
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Patient Forms<\/h1>\n\n<\/div>\n\t<\/section>\n\n\n\n
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Getting Ready for Your Teen\u2019s Mental Health Visit<\/h2>\n\n\n\n

These are forms that\u00a0Dr. Timothy Blumer<\/a>\u00a0uses when treating children or teens.\u00a0Samaritan Mental Health \u2014 Circle Blvd<\/a>.\u00a0will let you know which forms to fill out. Click on the form name to open or download.<\/p>\n\n\n\n

\u2022 ADHD rating scale IV (home version).<\/a>
\u2022 ADHD rating scale IV (school version).<\/a>
\u2022 ADHD rating scale IV (self report version)<\/a>.
\u2022 Mood disorders questionnaire.<\/a>
\u2022 Mood chart (blank).<\/a>
\u2022 NIMH child life chart method.<\/a>
\u2022 SCARED – Screen for child anxiety related disorders (to be filled out by the child).<\/a>
\u2022 SCARED – Screen for child anxiety related disorders (to be filled out by the parent).<\/a>
\u2022 Social skills assessment (parent form).<\/a>
\u2022 Y-BOCS symptom checklist.<\/a>
\u2022 Youth Mania Rating Scale (parent version).<\/a>
\u2022 Youth Mania Rating Scale.<\/a><\/p>\n\n<\/div>\n\t<\/section>\n","protected":false},"excerpt":{"rendered":"

Patient forms to get ready for your teen’s mental health visit.<\/p>\n","protected":false},"author":26,"featured_media":0,"parent":10373,"menu_order":5,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_searchwp_excluded":"","_shs_workflow_notes":"","_shs_exclude_from_navigation":false,"_shs_promote_article_on_blogs":"","footnotes":""},"class_list":["post-10388","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/pages\/10388","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/users\/26"}],"replies":[{"embeddable":true,"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/comments?post=10388"}],"version-history":[{"count":0,"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/pages\/10388\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/pages\/10373"}],"wp:attachment":[{"href":"https:\/\/samhealth.org\/wp-json\/wp\/v2\/media?parent=10388"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}