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Web screen for child anxiety related disorders (scared) child version—page 1 of 2 (to be filled out by the child) developed by boris birmaher, m.d., suneeta khetarpal. Complete the order form and enclose in an envelope. The only handwritten marks we will accept when you use the form filler tool are your original signature and. Print a summary of responses you can print a summary page of your form questions, number of responses, and a chart for each question that shows a breakdown of how respondents answered that particular question.
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