All Program Participants are asked to return all of the applicable forms (below) to “Attention: HUGS” via fax at 239-330-7163.         

CONSENT FORMS – REQUIRED

SCREENING TOOLS

  • ASQ Social & Emotional Screening for children 3 Months to 6 years- (*THESE WILL COME DIRECTLY TO HUGS FROM THE BELOW LINK)  Please click here

  • SDQ (Strengths & Difficulties) Questionnaire for children 6 to 18 years. (THESE WILL NOT BE AUTOMATICALLY DELIVERED TO HUGS AND MUST BE PRINTED AND SENT TO HUGS or CALL TO REQUEST THE FORMS) Digital-SDQFormEnglish  Please click here

AUTHORIZATION

  • Release form (for release of information) This may be completed for a Doctor or other service provider but IS NOT MANDATORY.  Digital Authorization to Release Information English.doc2019 (dragged)Authorization to Release Information

Por favor, devuelva todas las formas abajo, por fax al 239-330-7163 – “Atención: HUGS”

FORMA DE CONSENTIMIENTO

CUESTIONARIO DE ASQ (SOCIAL EMOCIONAL)

CUESTIONARIO DE SDQ (FUERZAS Y DIFICULTADES)

Forma de Autorización Para Usar o Divulgar la Información Protegida de SalúdDigital Authorization to Release Information Spanish