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

Go to > Adolescent Health Care Resources | Go to > Adolescent Health Gateway

To view the PDF files, you will need Adobe Acrobat Reader (free download from Adobe's Web site).

For questions about this page, please contact the Adolescent Health program.

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