Problematic Sexual Behavior Consultation

Problematic Sexual Behavior Consultation

This form will take approximately 10 minutes to complete.
Thank you for reaching out for a PSB consultation. The intersection of trauma and mental health can be challenging for many families. To make the most of your consultation session, please answer the following questions.
Name of Individual completing the form:

First NameLast Name
Relationship to the child:
State of Residence:
Email:
example@example.com
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
What behavioral or social/emotional challenges does your child have? Any mental health diagnoses?
What sexual behaviors is your child currently exhibiting that are concerning to you? Please include how long these behaviors have been going on and if they have ever involved another child/adolescent in their behaviors.
What is your child’s current level of support? Examples would include previous or current therapy modalities, psychiatrists, in school supervision, home safety plan in place, etc.
What is working well about your child’s current support?
What are the top 2 concerns you have that you would like to address during your consultation?
Any additional information you would like to share or questions you have?
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