Medicare Annual Wellness Visit Questionnaire
Please complete the following assessment PRIOR to your Annual Wellness Visit. Your provider will review this assessment with you during your visit.
Questions marked with a (*) are required and must be answered before you can submit the assessment.
Medicare Health Risk Screening
Patient Health Questionnaire (PHQ-9)
Over the last 2 weeks, how often have you been bothered by any of the following problems?
The Alcohol Use Disorders Identification Test
Thank you for completing this questionnaire. Please click Submit Form when you are finished.