Sunil N. Lalla, M.D. PA, Bharti Lalla, M.D. FAAP

Available Forms

ADULT Telemedicine Patient Consent Form (Dr Sunil Lalla patients) CHILDREN < 3 yearsM-Chat Form (Children age < 3 years) CHILDREN Annual depression screening PHQ 9 (Children < 18 years) CHILDREN Registration form Dr Bharti Lalla (New Patient) CHILDREN Sports Physical Form CHILDREN Tuberculosis Questionnaire (Children < 18 years) Immigration (New Patient) Immigration (New Patient) SPANISH Six min WALK ADULT Medical History (New Patient) Dr. Sunil Lalla Sleep History (Initial history) ADULT Registration form Dr S Lalla (New Patient) Sleep apnea (Epworth sleepiness scale)

CHILDREN Annual depression screening PHQ 9 (Children < 18 years)

Bharti Lalla MD PA

First Name *

Last Name *

Date of Birth *

Date of Completion *

New Field17

Little interest or pleasure in doing things *

Feeling down, depressed or hopeless *

Trouble falling or staying asleep or sleeping too much. *

Feeling tired or having little energy. *

Poor appetite or overeating. *

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

Trouble concentration on things such as reading the newspaper or watching TV. *

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. *

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

* Required field