7-17 year olds. To be completed by parent or guardian prior to telephone consultation with a Specialist.

Please complete all questions and press submit. This will be sent to a Linden Method Support Specialist who will then be in touch advising how we might be able to help you and your child.

We abide by GDPR data protection laws and respect yours and your child's privacy and all information is held in the strictest of confidence. This information is not shared with any third parties and will be securely destroyed after the telephone consultation if you do not join the program. If you join the program the information may be retained for the duration of the support period (12 months).

You have a right to request any information that is stored by us, at any time, by sending a Subject Information Request to julie@thelindencentre.org

If you wish to view our Privacy Policy, please visit our website:
  • Please be as honest as you can with your answers - This information will not be divulged to a third party.
  • Child's Symptoms and Behaviours

    We appreciate that you may not be aware of every symptom they are experiencing, so please just tick those you know about.
  • YES
    Generalized Anxiety Disorder
    Panic Attacks
    Monophobia (fear of being alone)
    Emetophobia (fear of vomiting)
    OCD (Obsessive Compulsive Disorder)
    Post Traumatic Stress Disorder
    Social Anxiety Disorder
    Health Anxiety
    Pure O (Inappropriate thoughts)
    Low mood
    Night-time panic attacks
    Fear of dying
    School Phobia
  • YES
    Does your child take prescription medication for their anxiety?
    Does your child suffer from diabetes or other endocrine disorders?
    Has your child ever been diagnosed with clinical depression?
    Has your child ever been diagnosed with a psychosis?
  • Please write anything in the box above that you feel might be relevant to your child's condition.
Your assessment will be handled by an accredited Anxiety Recovery Expert.