Follow-Up Psychiatric Visit Questionnaire

INITIAL PSYCHIATRIC INTAKE QUESTIONNAIRE

Since last visit, overall symptoms

Better Same Worse

Depression

Better Same Worse

Anxiety

Better Same Worse

Sleep

Better Same Worse

Medication adherence

Good Some missed doses Stopped medication

Medication benefit

Side effects

New medications/medical conditions/substance use

Safety: suicidal thoughts

No Yes

homicidal/violent thoughts

No Yes

Patient goals/questions

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