Please indicate how much the following problems have bothered you during the past week. Mark only one box for each problem, and be sure to answer all items.
Even though these conversations with your doctor may be difficult, you may want to print this page out and use it as a potential conversation starter with your healthcare provider to aid in a psychiatric evaluation if warranted.
*This screen does not take the place of a physician's diagnosis. Patients are strongly urged to seek the advice of your physician or a qualified therapist prior to starting any new treatment or therapy or with any questions you may have regarding a medical, mental, or emotional condition.
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