After completing this questionnaire, sending your results takes two steps:
Step 1: Download - Tap "Download results file" to save it to this device.
Step 2: Email - Tap "Open email", enter your child's email address, attach the file you just downloaded, and send. Your email will not attach it for you.
Note: Your child will then forward your results to their clinician.
Important Notice:
This questionnaire is for information gathering purposes only and is not diagnostic. The responses you provide will be reviewed by a clinician as part of a comprehensive clinical assessment. Only a qualified healthcare professional can make diagnostic or treatment decisions. Please answer honestly based on your actual memories.
Privacy: All data is processed locally on your device. Nothing is sent anywhere until you choose to download and share your results file with your clinician. Your answers are also saved automatically on this device as you go, so you can close this page and come back later to finish.
Instructions for Parent: You have been asked to complete this questionnaire about your child's behaviour when they were between 7 and 12 years of age.
📝 Answering Questions: You may leave questions blank if you're unsure or they don't apply. Don't guess - skipped items will be excluded from score calculations. However, try to answer as many as you can for accurate results.
0 of 26 items answered (26 skipped) (0%)
Information
Only used if Dr Shah needs to clarify something with you directly. You do not have to provide this.
Childhood Behaviour (Ages 7-12)
Rate your child's behaviour when they were between 7 and 12 years of age
0 = Never/rarely1 = Sometimes2 = Often3 = Very often (several times per hour/day)
Impact on Daily Life (Ages 7-12)
To what extent did these behaviours interfere with your child's functioning between ages 7-12?
0 = Never/rarely1 = Sometimes2 = Often3 = Very often (several times per hour/day)
✓ Questionnaire Complete
Thank you for completing this questionnaire
Your responses have been saved. Please send your results to your child using one of the options below.
Your clinician will review these results and schedule the next step (a structured clinical interview) before any diagnostic conclusions can be reached.
Send Results to Your Child:
Before you send: attach your file
Your email does not attach the file for you. Please attach the file below to your email, then send.
The file to attach (saved to this device just now):
If it saved as .bin or .txt instead of .enc, that is fine, your clinician can still open it.
How to send: First tap "Download results file". Then tap "Open email", enter your child's email address, attach the downloaded file shown above, and send it to them.
Your child will then forward your responses to their clinician (Dr. Shah at draanashah@protonmail.com).