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)  Please click here

AUTHORIZATION

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 Salúd