PEARLS

The Pediatric ACEs and Related Life-events Screener is used in our practice to screen children and adolescents for ACEs (Adverse Childhood Experiences). It's important that you answer the survey honestly, in order to ensure that we help you and your child in the best way possible. :D

If you are a parent of a young child under 12, please print the first form below, answer it accordingly, and bring it to your next visit.

If your child is 12 or over, please fill out the second form below, and have him/her/them fill out the third.

PEARLS Forms (English)

Child (<12)

Please print the survey below, fill it out, and bring it to your next visit with us.

Child Form

Teenager

Please print the survey below, fill it out, and bring it to your next visit with us. Please note that this form is for the parent of the teenager to fill out.

Teen Form

Encuestas de PEARLS (Español)

Niño (<12)

Imprima la encuesta debajo, complétela, y tráigala a su próxima cita con nosotros por favor.

Niño

Adolescente

Imprima la encuesta debajo, complétela, y tráigala a su próxima cita con nosotros, por favor. También reconozca que esto es para que los padres lo llenen.

Adolescente

Children's Medical Group

QUALITY PEDIATRIC CARE

for over 30 years

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PEARLS

PEARLS Forms (English)

Child (<12)

Teenager

Encuestas de PEARLS (Español)

Niño (<12)

Adolescente