Please let us know which of the following symptoms you’ve noticed your child has experienced:
Social withdrawal Intense Anxiety Loss of appetite Loss of hygiene Delusions Difficulties processing information Hearing/seeing things that aren’t there Feeling depressed/causing self-harm NONE
Has your child been treated with schizophrenia before?
Is your child currently receiving treatment for schizophrenia?
Does your child have a history of any of the following?
Seizure Disorder Stroke Head Injury Brain Tumor Cancer NONE
What is your child's gender?
How old is your child?
Parent's Name (First and Last):
Child's Name (First and Last):
Is the child a resident of Washington State?
What is the best time to contact you?
How did you hear about us?
TV Radio Referral Flyer/Brochure Internet Search Web Advertisement Facebook Previous Patient Parent Map Seattle’s Child School PTA
Please enter any questions or comments in the space below.
Your information will not be shared with or sold to anyone without your permission or except as required by law. See our Privacy Statement for details.
I agree to the Privacy Statement
IMPROVING PEOPLE'S LIVES THROUGH RESEARCH