Anxiety & Depression

How are you feeling?

How are you feeling today?

Which of the following best describes why you are seeking help?

Help us understand the severity of your anxiety and depression

Over the past 2 weeks, how often have you been bothered by having little interest or pleasure in doing things?

Over the past 2 weeks, how often have you been bothered by feeling down, depressed, or hopeless?

Over the past 2 weeks, how often have you been bothered by an inability to fall asleep, stay asleep, or that you're sleeping too much?

Over the past 2 weeks, how often have you been bothered by feeling tired or having little energy?

Over the past 2 weeks, how often have you been bothered by a poor appetite or poor eating habits?

Over the past 2 weeks, how often have you been bothered by feeling bad about yourself, that you are a failure, or that you have have let yourself or your family down?

Over the past 2 weeks, how often have you been bothered by the inability to concentrate on things such as reading the newspaper or watching TV?

Over the past 2 weeks, how often have you been bothered by moving or speaking so slowly that other people have noticed, or being so fidgety or restless that you have been moving around a lot more than usual?

Over the past 2 weeks, how often have you been bothered by feeling nervous, anxious, or on edge?

Over the past 2 weeks, how often have you been bothered by not being able to control your worrying?

Over the past 2 weeks, how often have you been bothered by worrying too much about different things?

Over the past 2 weeks, how often have you been bothered by an inability to relax?

Over the past 2 weeks, how often have you been bothered by being so restless that it is hard to sit still?

Over the past 2 weeks, how often have you been bothered by your ability to become easily annoyed or irritable?

Over the past 2 weeks, how often have you been bothered by feeling afraid as if something awful might happen?

Over the past 2 weeks, how difficult has it been for you to do your work, take care of things at home, or get along with other people?

When did your symptoms first begin?

What have you previously tried?

Have you used any of the following mental health medications in the past?

Let's find the right treatment for you

If you have tried a previous treatment, what was that treatment, was it successful, and are you still using it?

Is there anything else related to treatment that you'd like to ask or discuss with your medical provider?

Do you have a preferred treatment?

Would you like to share anything else with your provider through an upload?