Patient resources
Forms
Rating scales we may ask you to complete before or between visits. Each opens on the publisher's website; print or download it, fill it in, and bring it to your appointment or send it to the practice.
-
Epworth Sleepiness Scale
An eight-question scale of how likely you are to doze off in everyday situations. It helps us gauge daytime sleepiness and decide whether further sleep evaluation is needed. Published by the CDC / NIOSH (PDF).
-
Vanderbilt ADHD Assessment Scales
Parent and teacher rating scales for children and adolescents being evaluated for ADHD. Ask your child's teacher to complete the teacher form. Published by UW Health.
-
CRAFFT 2.1 Questionnaire (for teens to complete)
A brief, confidential screening questionnaire about alcohol and drug use for adolescents ages 12 to 21. Teens fill this out themselves; it takes about two minutes. Developed by Boston Children's Hospital (PDF). A clinician-interview version is also available.
-
IAPMD Premenstrual Symptom Tracker
A daily symptom diary for suspected PMDD or premenstrual exacerbation. Track for two full menstrual cycles before your visit so that we can see the pattern together. From the International Association for Premenstrual Disorders; see the Women’s Mental Health page for more.
Completed forms can be brought to your visit or sent to natashawisconsinpsychiatry@gmail.com. Please note that email is not a secure channel for detailed clinical information.