Adolescent and Young Adult (AYA) Health Questionnaire

The AYA Health Questionnaire is an optional, youth self-report tool that clinics can use routinely for patients ages 11-20 years when they check in for their C&TC/well visit. The questionnaire helps identify a young person's current health strengths and risks, can be used as a clinical tool for health history and risk assessment, and can help efficiently focus the visit on the young patient's needs and health goals. The questionnaire includes information about general health, safety, sexual health, substance use, and more.

• Guidance for Clinics: Using the AYA Health Questionnaire (PDF) - Please review this guidance prior to implementing the AYA Health Questionnaire into clinical practice. It includes recommendations for introducing the tool to patients and family, resources related to minors' consent and confidentiality, and rationale and resources for some of the items on the questionnaire.
  
  
  • Adolescent and Young Adult Health Questionnaire (PDF) - (English)
  
  
  • Exploración de Salud de Adolescentes (PDF) - (Spanish)

Please note that the questionnaire is not standardized screening and cannot be billed as such. Separate standardized mental health screening is required. For more information about mental health or depression screening in young people 6-20 years of age, refer to the C&TC Mental Health Screening (6-20 years) Fact Sheet (PDF).