FORMS

For some referrals it is very helpful for us to have additional information. Please complete any requested forms and drop them off at our office or fax them to 250.881.7349 before your appointment if possible.

If you have been instructed to fill out forms for Dr. Ferguson, you can click on the button below to access her forms.

CLICK HERE TO ACCESS DR. FERGUSON’S FORMS

The forms below are used for screening purposes only and may help us better assess certain conditions. If your child is school age please bring report cards to the appointment.

The forms below are interactive and can be filled out on your computer. To fill out forms on your computer, click on the form icon and a new window will open enabling you to fill in all text fields as well as check boxes, etc.
If the interactive form fields are not working on your device, you may need to download Adobe Acrobat. You can download and install that program here for free.
Once you have completed the form you can select Save at the top of the page. Select the Save On My Computer option and the form will download to your device. Check your Downloads folder for the completed form.

1. PARENT QUESTIONNAIRE

2. CPS PRESCHOOL/KINDERGARTEN QUESTIONNAIRE (5 AND UNDER)

3. CPS SCHOOL QUESTIONNAIRE (6-18)

4. CADDRA TEACHER ASSESSMENT FORM

5. SNAP IV (PARENT & TEACHER)

6. SCHOOL AGE DEVELOPMENTAL SCREEN (WSR)

7. ADHD FUNCTIONAL IMPAIRMENT (WEISS) PARENT REPORT

8. ADHD FUNCTIONAL IMPAIRMENT (WEISS) SELF REPORT

9. ADHD ASSESSMENT Q (VANDERBILT)PARENT

10. ADHD ASSESSMENT Q (VANDERBILT) TEACHER

11. ADHD FOLLOW UP Q (VB) PARENT

12. ADHD FOLLOW UP Q TEACHER

13. ANXIETY SCARED Q-CHILD

14. ANXIETY SCARED Q-PARENT

15. TEEN DEPRESSION SCREEN (KADS)

16. DEVELOPMENTAL COORDINATION DISORDER Q

17. GENERALIZED ANXIETY SCORE SHEET

18. DEPRESSION SCALE & QUESTIONNAIRE

19. PSC 17 RATING SCALE

20. RCADS

21. MCHAT

22. CAST

23. ONTRAC – PARENT & FAMILY CHECKLIST

24. ONTRAC – Youth Quiz