Child Assessment

Please complete the following questionnaire to help determine if Eagle Valley Youth Ranch is the right solution for your teen.

All information submitted is confidential. The results will be displayed upon pressing the "Submit Assessment" button.

How your Assessment will be scored —
Scale:

<1000: Indication that outpatient counseling, or parent counseling/coaching may be needed.

>1000: Indication that treatment at Eagle Valley Youth Ranch or other residential facility may be needed.

>3000: Strong Indication that treatment at Eagle Valley Youth Ranch or other residential facility may be needed.

Part 1: Has your teen exhibited problems that might be a result of...
Traumatic events in his/her life?(i.e. abuse, divorce, death, adoption, etc.)
	Yes	No
Learning disabilities or ADHD/ADD?
	Yes	No
Inability to manage anger?
	Yes	No

Part 2: Within the last six months...
Has your teen seemed depressed/withdrawn?
	Yes	No
Have you suspected your teen of stealing from you or others?
	Yes	No
Have you suspected your teen is abusing drugs or alcohol?
	Yes	No
Has your child been able to escape consequences due to the ability to manipulate people and situations or does your child blame others for his/her problems?
	Yes	No
Has your child disregarded family rules and parental guidance?
	Yes	No
Has your teen had problems in school? (i.e. poor grades, challenging authority, etc.)
	Yes	No
Has your teen been destructive to property?
	Yes	No
Has your teen implied that he/she has a plan for suicidal behavior?
	Yes	No
Has your teen exhibited symptoms of an eating disorder?
	Yes	No
Has your teen run away from home?
	Yes	No
Has your teen been promiscious or associating with a poor choice of peers?
	Yes	No

Part 3: Enter the following
Your Name:
Your Email Address: