A Healthy State of Mind Just another WordPress site
  • Home
  • About
    • About Dr. Fry
    • Philosophy & Mission
    • Testimonials
  • Services
    • What to Expect
    • Treatment Approaches
    • Naturopathic Medicine
    • Homeopathy
    • Chronotherapy
    • Telemedicine
  • Education
    • Classes & Events
    • Blog
    • Resources
  • FAQ
  • Patient Forms
  • Contact
The properties of water...

Patient Forms

Click below to download PDF

New Patient Forms

• Welcome letter

• Patient Intake Form

• Notice of privacy practices

• Consent form

Screening Tools Forms

To be completed prior to your first visit:

• Anxiety symptoms – GAD-7

• Obsessive-Compulsive symptoms- Y-BOCS

• Depressive symptoms- PHQ-9

• Depressive/Bipolar symptoms- MDQ

• Morningness-Eveningness Questionnaire -MEQ

• Physical/Somatic Screener- PHQ-15

• PTSD Screener- Civilian Version- PCL-C

• Measure Your Medical Outcome Profile- MYMOP

Symptom Logs

• Bipolar Mood Charting (Mood Diary)

Established Patient Forms

• Release of records authorization form

• Communication consent form – Practitioner

• Communication consent form – Family

Patient Virtual Dispensary

.

1940 NE Broadway St. • Portland, OR 97232 • Tel. 971-678-6243 • Fax: 1-971-275-1738