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Available Forms

2024 NEW PT Patient Questionnaires

Patient Health Questionnaire (PHQ-9)

Please select the option that best describes you.

Little interest or pleasure in doing things *

2. Feeling down, depressed, or hopeless *

3. Trouble falling or staying asleep, or sleeping too much *

4. Feeling tired or having little energy *

5. Poor appetite or overeating *

6. Feeling bad about yourself ? or that you are a failure or have let yourself or your family down *

7. Trouble concentrating on things, such as reading the newspaper or watching television *

8. Moving or speaking so slowly that other people could have noticed? Or the opposite ? being so fidgety or restless that you have been moving around a lot more than usual *

9. Thoughts that you would be better off dead or of hurting yourself in some way *


For Office Coding:

If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?


Generalized Anxiety Disorder 7-item (GAD-7) scale

You are allowed to leave the total score blank. The provider will review your score for you.

Source: Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder. Arch Inern Med. 2006;166:1092-1097.



Tranquility Behavioral Health Abnormal Movement Questionnaire

Are you having any body movements you can't control? Have others noticed or commented on particular movements? Please select a description of the movements from the options below.

If the section does not apply, please input N/A in the allotted space.



Answer Yes OR No. Then, DESCRIBE


If the section does not apply, please input N/A


Answer Yes OR No. Then, DESCRIBE

Abnormal Movement Questionnaire will be submitted to Gero-Psychiatric & Behavioral Health Consultants LLC DBA Tranquility Behavioral health LLC

* Required field