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

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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.

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