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).
*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.
Level of Disability, Self Report
*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)
Patients Concerned about Focus Difficulties and Hyperactivity
Physical or Verbal Aggression
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.