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Consent for Tele-Health Services
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Influenza Vaccine Consent and Screening Form for Adults
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Influenza Vaccine Consent and Screening Form for Adults (Revised without intranasal)
General Medical - Adult
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Adult Primary Care Screening Tool
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Adult Self-Report (ASR)*
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DHCS 7098 H - Staying Healthy Assessment Adult (SHA Adult)
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DHCS 7098 I - Staying Healthy Assessment Senior (SHA Senior)
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Generalized Self-Efficacy Scale (GSES)
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International Prostate Symptom Score (IPSS)
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Resilience Builders Group Encounter
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Safety Checklist: 18-21 Years Young Adult
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STEADI - Stopping Elderly Accidents Death & Injuries
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Vulnerable Elder Survey
General Medical - Asthma
General Medical - Data Collection
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Advocate Medical Group Intro
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Patient Demographics - General
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Pre Appointment COVID Screener
General Medical - General
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Family Cardiac History
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Family Medical History
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Family Questions
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Sexuality and Gender Questionnaire
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Visit Priorities
General Medical - JCAHO Specific
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Communication Preferences (JCAHO) and Patient Safety Screen
General Medical - Past History
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Family Cardiac History
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Family Medical History
General Medical - Social Determinants of Health
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Adverse Childhood Experiences and Positive Childhood Experiences (ACE/PCE)
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Alcohol Use Disorders Identification Test-Consumption (AUDIT-C)
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Family Questions
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Health Screening - SDoH
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Hurt, insulted, Threatened with Harm, and Screamed - Partner Version (HiTS-P)
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PC-PTSD
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PRAPARE: Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE)
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Protective Factors Survey (PFS)
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Psycho-social Screener
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Revised Dyadic Adjustment Scale (RDAS)
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The Hunger Vital Sign
General Medical - Special Health Care Needs
General Medical - Sports
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Sport Concussion Assessment Tool ™ - 6 Immediate Assessment /Neuro Screen
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Sport Concussion Assessment Tool ™ - 6 Off-Field Assessment
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Sport Concussion Assessment Tool ™ - 6 Athlete Information and Concussion History
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Sport Concussion Assessment Tool - 3rd edition: Self-administered background and symptom evaluation for patients 13 years+
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Concussion Assessment Tool 2: Symptom EvaluationSport
General Medical - Vaccination Information
Mental Health - Abnormal Movements
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Yale Global Tic Severity Scale (YGTSS)
Mental Health - ADHD
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Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist
Mental Health - Anxiety
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Anxiety screen for adults - English
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Anxiety screen for adults short version
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Screen for Adult Anxiety Related Disorders (SCAARED)
Mental Health - Borderline
Mental Health - Depression/Mood Disorders/Suicide
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Ask Suicide Screening Questions (ASQ)
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Columbia-Suicide Severity Rating Scale
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Launch Weekly Assessment Measure
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Mood and Feelings Questionnaire: Adult Self-Report Long Version (MFQ: Adult Self-Report Long Version)
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Mood and Feelings Questionnaire: Adult Self-Report Short Version (MFQ: Adult Self-Report Short Version)
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Multidimensional Behavioral Health Screen 2.0
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PHQ-9 for Adults
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PRIME-MD PHQ-2 (PHQ-2)
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The 7 Up 7 Down Inventory
Mental Health - Diagnostic
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Diagnosis Reporting Tool
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Weiss Symptom Record (WSR)
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Weiss Symptom Record II
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Weiss Symptom Record II without Suicide Items
Mental Health - Eating Disorders
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Eating Attitudes Test (EAT 26)
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SCOFF
Mental Health - Family/Environment
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Adverse Childhood Experiences and Positive Childhood Experiences (ACE/PCE)
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Alcohol Use Disorders Identification (AUDIT-C) Test—Consumption
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Family Questions
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McMaster Family Assessment Device, General Functioning Subscale
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Parental Stress Scale
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PRAPARE: Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE)
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Protective Factors Survey (PFS)
Mental Health - General Adult
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ABASI Self-injury Questionnaire
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Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist
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Anxiety Screen for Adults
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Anxiety Screen for Adults short version
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Alcohol Use Disorders Identification Test—Consumption (AUDIT-C)
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Balanced Measure of Psychological Needs Scale (BMPN)
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CAGE-AID
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DAST-10* Drug Abuse Screening Test*
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Emerging Adults Developmental Milestones Questionnaire
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IDEA: Inventory of the Dimensions of Emerging Adulthood
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KIMS - Kentucky Inventory of Mindfulness Skills
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Mood and Feelings Questionnaire: Adult Self-Report Long Version (MFQ: Adult Self-Report Long Version)
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Mood and Feelings Questionnaire: Adult Self-Report Short Version (MFQ: Adult Self-Report Short Version)
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Older Adult Self-Report (OASR)*
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Opioid Risk Tool – 2 (ORT 2)
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Parental Stress Scale
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Patient Health Questionnaire 4 (PHQ-4)
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Patient Health Questionnaire 9 (PHQ-9 for Adults)
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PRIME-MD PHQ-2
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Problematic and Risky Internet Use Screening Scale 18 (PRIUSS-18)
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UCLA Loneliness Scale Version 3
Mental Health - Obsessive-Compulsive
Mental Health - Personality Disorder
Mental Health - Substance
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Alcohol Use Disorders Identification Test—Consumption (AUDIT-C)
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CAGE-AID
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Cannabis Use Disorders Identification Test - Revised (CUDIT-R)
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Drug Abuse Screening Test 10 and AUDIT (DAST-10 and AUDIT)*
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Drug Abuse Screening Test: 10 item version (DAST-10)*
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GPRA Behavioral Health Form Client Facing
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GPRA Behavioral Health Form Staff Facing
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GPRA Office Form
* These questionnaires may have an additional cost associated with them. Ask your account manager or sales representative for details.