Adult Mental Health Questionnaires

Forms to fill out to help the doctor with your care before your first visit and during your treatment.

Filling out questionnaires that apply to your situation before your visit, and during care, allows for greater depth and time to go into detail in the office. We highly recommend utilizing this resource. (please disregard instructions for clinicians and do not attempt to score at home, just answer the numbered questions and bring them to your office visit).

 

Anxiety

Anxiety Questionnaire
*This form can be answered by a patient, some of the terms are clinical and meant for the doctor. Answer to the best of your ability and any questions can be answered in the office.

 

Concern about Change in Intellectual Functioning

Intellectual Functioning Test to Be Given to Patient by Another Person, Not a Self-Report
*This form may be difficult to fill out without a clinician. It can also be done in the office.

 

Depression

Depression Questionnaire Self Report – Long Version

Depression Questionnaire Self Report – Short Version

 

Down Syndrome

Dementia Screening for Patients with a Diagnosis of Down Syndrome

 

Level of Disability, Self Report

Level of Disability, Self Report – Long Version (whodas 2.0)

Level of Disability, Self Report – Short Version (whodas 2.0)

*This questionnaire helps determine the effect of the disorder on your functioning.
© World health organization, 2012. Measuring health and disability: Manual for WHO disability assessment schedule (WHODAS 2.0), World health organization, 2010, Geneva.

 

Menstrual Cycle Related Mental Health Concerns (Females)

Daily Record of Symptoms in Relation to the Menstrual Cycle

 

Patients Concerned about Focus Difficulties and Hyperactivity

ADHD Questionnaire

 

Physical or Verbal Aggression

Physical or Verbal Aggression Questionnaire

 

Sleep Problems

Sleepiness Scale

Two-week sleep diary
*This sleep diary will help identify issues related to sleep and track improvements over time

Adverse Life Events / Traumatic Experiences

Adverse Childhood Experiences International Questionnaire
*This questionnaire describes difficult or traumatic early life experiences as a starting point for discussion with your provider.

*All forms listed above are provided as a courtesy for our patients. Mental Fitness Clinic is not responsible for any material provided by websites other than www.mentalfitnesclinic.com.