Adolescent and Young Adult Health Questionnaire

The Adolescent and Young Adult (AYA) Health Questionnaire is a youth self-report tool that clinics can routinely use for patients ages 11-20 years when they check in for their Child and Teen Checkup (C&TC)/well visit. The questionnaire includes information about general health, safety, sexual health, substance use, and more. It can be used as a clinical tool for health history and risk assessment. The questionnaire helps the provider identify and focus on a young person's current health strengths, risks, needs and goals.

• Adolescent and Young Adult Health Questionnaire (PDF) - (English)
• Additional languages available on C&TC Translated Documents web page

Before implementing the AYA Health Questionnaire into clinical practice, please review the Guidance for Clinics: Using the AYA Health Questionnaire (PDF) document. It includes recommendations for introducing the tool to patients and family, and provides resources related to minors’ consent, confidentiality rights. There is also a section that provides both rationale and resources related to specific the items on the questionnaire.

*Note this questionnaire is not and cannot be billed as a standardized screening. Separate standardized screening is required. For more information about screening for mental health or depression in young people 6-20 years of age, refer to the C&TC Mental Health Screening (6-20 years) Fact Sheet (PDF).