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2024-05-18T18:32:48-05:00
Patient's first name
*
Age
*
Patient's Last Name
*
Sex
Male
Female
Non-binary
Have you been diagnosed with a psychiatric problem before?
*
I have not been diagnosed with any psychiatric problem before
Depression
Trouble sleeping
Anxiety
Bipolar disorder
Schizophrenia
Obsessive Compulsive Disorder
Eating Disorder
ADHD
PTSD (Post traumatic stress disorder)
How would you describe your reason for this appointment?
*
Lets check for presence of depressive symptoms. If no symptoms are present, click on none.
*
None
feeling sad,
having poor energy and motivation,
feeling helpless,
feeling hopeless,
unable to enjoy things that use to be fun,
episodes of being tearful,
feeling worthless,
having poor self-esteem,
feeling like I don't care that if I live or die,
thoughts of self injurious behavior,
thoughts of suicide
You can add more depression symptoms here if any.
You can add more depression symptoms here if any.
Lets check for presence of anxiety symptoms. If no symptoms are present, click on none.
*
None
being worried all the times,
restlessness,
on edge all the times,
unable to relax,
anxious in social situations,
afraid to try new things,
fear of driving,
fear of heights,
fear of water,
fear of travel and flying
You can add more anxiety symptoms here if any.
You can add more anxiety symptoms here if any.
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