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SCREENING TOOLS


Our forms are written with you in mind. We hope to gather as much information now, in order to be able to focus on your individual goals with therapy during an SKC Consultation.

client

For this questionnaire (Short-form McGill Pain Questionnaire 2 / SF-MPQ-2), I will provide you a list of words that describe some of the different qualities of pain and related symptoms. Please rate the intensity of each of the pain and related symptoms you felt during the past week on 0 to 10 scale, with 0 being no pain and 10 being the worst pain you can imagine. Use 0 if the word does not describe your pain or related symptoms. Limit yourself to a description of the pain related to your surgery or pelvic pain.

CONDITION TREATED: Chronic Pain

The Altman Self-Rating Mania Scale (ASRM) is a 5-item self-rating mania scale, designed to assess the presence and/or severity of manic symptoms. It may be used n an inpatient or outpatient setting to screen for the presence of and/or severity of manic symptoms for clinical or research purposes.

CONDITION TREATED: Mania / Bipolar Disorder

The Mood Disorder Questionnaire (MDQ) was developed by a team of psychiatrists, researchers and consumer advocates to address the need for timely and accurate evaluation of bipolar disorder.

CONDITION TREATED: Bipolar Disorder

A rating instrument for anxiety disorders. For each item, place a checkmark in the column which best decsribes how often you felt or behaved this way during the past several days. Bring the completed form with you to the office for scoring and assessment during your office visit.

CONDITION TREATED: Anxiety

The Quick Inventory of Depressive Symptomatology (QIDS SR-16) scale is a self-report measure of depression.

CONDITION TREATED: Major Depressive Disorder

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is a series of questions that allow us to understand how severe your Obsessive Compulsive Disorder (OCD) may be.

CONDITION TREATED: Obsessive Compulsive Disorder (OCD)

The following questions concern information about your possible involvement with drugs not including alcoholic beverages during the past 12 months.

CONDITION TREATED: Substance Use