Pediatric Mental Health Screening Consent Form

Streamline Pediatric Mental Health Screening with a Professional Consent Form

Early intervention in pediatric mental health can make a profound difference in a child's development and wellbeing. This Pediatric Mental Health Screening Consent Form template provides healthcare providers, school counselors, and mental health professionals with a comprehensive, HIPAA-compliant solution for obtaining proper authorization while gathering essential clinical information.

Designed for Healthcare Professionals and Educational Settings

Whether you're a pediatric practice, child psychologist, school-based mental health program, or community health center, this template captures all the information needed for a thorough initial assessment. The form guides parents and guardians through consent for screening, treatment authorization, and information release while collecting critical data about family history, school performance, current medications, and behavioral concerns.

Complete Clinical and Administrative Coverage

This template goes beyond basic consent by integrating clinical screening questions with administrative requirements. You'll gather parental consent for evaluation, HIPAA authorization for sharing protected health information with schools and other providers, emergency contact details, insurance information, and detailed background on the child's developmental, social, and academic functioning. The structured format ensures you meet compliance requirements while building a complete clinical picture from the first interaction.

Seamless Workflows with Stepper and Papersign

Once a parent submits this form, you can use Stepper to automatically route the submission to your scheduling system, notify the appropriate clinician, update your EMR or practice management system, and trigger follow-up workflows for therapy referrals or psychiatry consultations. With Papersign, you can convert the consent portions into formal documents requiring secure eSignature, creating a legally binding authorization trail that's automatically linked to the original screening submission.

Built for Compassionate, Efficient Care

This template balances clinical thoroughness with a warm, parent-friendly tone. Conditional logic reveals relevant follow-up questions based on responses, reducing overwhelm while ensuring you capture all necessary details. For mental health professionals who want to provide excellent care while maintaining efficient intake processes, Paperform makes it possible to create a professional, branded screening experience that families trust and clinicians can rely on.