Website Screening Form

Please complete the form below if you are requesting the following services at Children’s Specialized Hospital:

    • Psychiatry*
    • Outpatient counseling
    • Group counseling/social skills group
    • Psychological testing*
    • Educational testing

*At Children's Specialized Hospital psychology and psychiatry services are available for children up to 18 years of age.
If you are requesting an appointment for any other outpatient services, please click here.
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Is the child for whom you are requesting
services currently receiving any of the
following? (check all that apply):






Did a physician or nurse practitioner from
Children’s Specialized Hospital refer you for counseling or psychiatry?:
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What services are you requesting
(check all that apply):






*

 
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1-888-CHILDREN
1-888-244-5373
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