Please fill out the relevant form AFter I work with your child to help me learn more~! Parent form Parents form Child's Name * First Name Last Name Email Caregivers Name & Relationship DOB Patient MM DD YYYY Date of Appointment MM DD YYYY What procedure is your child getting today? Rate your child's anxiety about the upcoming procedure before working with #ScrubSquad? What is your child's special interest or what is soothing for them? Is your child afraid of any medical equipment (scrubs, shots, masks)? Rate your child's anxiety after the procedure. Do you have any feedback you would be willing to share ? Thank you so much for allowing me to spend time encourage your child to cope through their fears so they could have confidence through their procedure! I will get back to you soon with your child’s results! Please feel free to explore my website. Professionals form Professional form Name * First Name Last Name Email * Profession Patient's Name First Name Last Name Have you ever had this client before? Rate their anxiety on the last visit. Rate their anxiety this time. Do you think #Scrub Squad was helpful? Thoughts, suggestions, questions? Thank you for taking the time to help #Scrub Squad grow please refer to Anxiety scale for forms Template for Working with your child!
