Patient resources

Forms

Rating scales we may ask you to complete before or between visits. Each opens on the publisher’s site; fill it in and bring or send it.

• Epworth Sleepiness Scale

  Eight questions on how likely you are to doze off in everyday situations; gauges daytime sleepiness and the need for further sleep evaluation. CDC/NIOSH (PDF).

• Vanderbilt ADHD Assessment Scales

  Parent and teacher rating scales for ADHD evaluation; ask your child’s teacher to complete the teacher form. UW Health.

• CRAFFT 2.1 Questionnaire (for teens to complete)

  A two-minute confidential screen for alcohol and drug use, ages 12 to 21, completed by the teen. Boston Children’s Hospital (PDF); clinician version.

• IAPMD Premenstrual Symptom Tracker

  Daily symptom diary for suspected PMDD or premenstrual exacerbation; track two full cycles before your visit. IAPMD; see Women’s Mental Health.

Bring completed forms to your visit or send them to natashawisconsinpsychiatry@gmail.com (email is not secure for detailed clinical information).

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