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.

GO TO FORM

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.

GO TO FORM

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.

GO TO FORM

The Hamilton Anxiety Scale (HAM-A) is a rating scale developed to quantify the severity of anxiety symptomatology, often used in psychotropic drug evaluation. It consists of 14 items, each defined by a series of symptoms. Each item is rated ona 5-point scale, ranging from 0 (not present) to 4 (severe).

GO TO FORM

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

GO TO FORM

The HAM-D is designed to rate the severity of depression in patients. Although it contains 21 areas, calculate the patient’sscore on the first 17 answers.

GO TO FORM

The SKC Prep

PATIENT HISTORY FORM

HIPPA RELEASE FORM

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.

GO TO FORM

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

GO TO FORM