A Healthy State of Mind
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  • About Dr. Fry
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  • Naturopathic
  • Homeopathy
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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

• Adult ADHD Screener- ASRS

• PTSD Screener- Civilian Version- PCL-C

• Measure Your Medical Outcome Profile- MYMOP

Symptom Logs

• Bipolar Mood Charting

Established Patient Forms

• Release of records authorization form

• Communication consent form – Practitioner

• Communication consent form – Family

  • Mission
  • About Dr. Fry
  • Services
  • Naturopathic Medicine
  • Homeopathy
  • Contact
  • Patient Info