Screening for Teen Health Risks
We are offering several versions of questionnaires used to question or screen teens about their health behaviors or risks.
- AMA GAPS (Guidelines to Adolescent Preventive Services). This is an initial, in depth, four page questionnaire.
- Teen Screen (long form) (PDF: 27KB/2 pages). This form has 22 questions and can be completed in about 5 minutes.
- Exploración de la Salud de Adolescentes (PDF: 32KB/2 pages) 22 preguntas
- Teen Screen (short form) (PDF: 64KB/1 page). This form has 10 questions and just covers the basics.
- Exploración de la Salud de Adolescentes (PDF: 63KB/1 page) 10 preguntas
- HEADSSS format. The HEADSSS format is a series of questions that cover the important areas of a teen's life. The questions may be memorized and blended into any teen visit. See HEADSSS Quick Screen or HEADSSS Long Form.
- Teen Progress Note (Ages 11-19) (PDF: 30KB/1 page)
Minnesota Health Improvement Partnership Adolescent Health Services Action Team in partnership with the Minnesota Department of Health, Updated 2006