Mental Health Assessment "*" indicates required fields Step 1 of 24 4% First, who needs care? Please enter your name, or the name of the person who will receive care. This will be kept confidential. First name* Zip code* Platinum Psychiatry is a fully remote service, but US law requires providers to be certified in the patient's state of residence. BACK What is your age? Less than 13 years old Between 13 and 17 years old Between 18 and 64 years old 65 years or older BACK In the past 2 weeks, how often have you experienced the following?Little interest or pleasure in doing things. Nearly every day More than half of days Several days Not at all BACK In the past 2 weeks, how often have you experienced the following?Feeling down, depressed, or hopeless. Nearly every day More than half of days Several days Not at all BACK In the past 2 weeks, how often have you experienced the following?Trouble falling or staying asleep, or sleeping too much. Nearly every day More than half of days Several days Not at all BACK In the past 2 weeks, how often have you experienced the following?Feeling tired or having little energy. Nearly every day More than half of days Several days Not at all BACK In the past 2 weeks, how often have you experienced the following?Feeling bad about yourself - or that you are a failure or have let yourself or your family down. Nearly every day More than half of days Several days Not at all BACK In the past 2 weeks, how often have you experienced the following?Trouble concentrating on things, such as reading the news or watching television. Nearly every day More than half of days Several days Not at all BACK In the past 2 weeks, how often have you experienced the following?Moving or speaking slowly that other people have noticed. Or the opposite - being so restless or fidgety that you have been moving around a lot more than usual. Nearly every day More than half of days Several days Not at all BACK In the past 2 weeks, how often have you experienced the following?Thought that you would be better off dead, or of hurting yourself in some way. Nearly every day More than half of days Several days Not at all BACK How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? Extremely difficult Very difficult Somewhat difficult Not difficult at all BACK Over the past 2 weeks, how often have you been bothered by the following problems?Feeling nervous, anxious, or on edge. Nearly every day More than half of days Several days Not at all BACK Over the past 2 weeks, how often have you been bothered by the following problems?Not being able to stop or control worrying. Nearly every day More than half of days Several days Not at all BACK Over the past 2 weeks, how often have you been bothered by the following problems?Worrying too much about different things. Nearly every day More than half of days Several days Not at all BACK Over the past 2 weeks, how often have you been bothered by the following problems?Having trouble relaxing. Nearly every day More than half of days Several days Not at all BACK Over the past 2 weeks, how often have you been bothered by the following problems?Being so restless that it is hard to sit still. Nearly every day More than half of days Several days Not at all BACK Over the past 2 weeks, how often have you been bothered by the following problems?Becoming easily annoyed or irritable. Nearly every day More than half of days Several days Not at all BACK Over the past 2 weeks, how often have you been bothered by the following problems?Feeling afraid as if something awful might happen. Nearly every day More than half of days Several days Not at all BACK Have you tried anxiety or depression treatment before? Yes No BACK What type of treatment have you tried? Therapy Psychiatry/medication Primary care Hospitalization or Partial Hospitalization Program (PHP) Intensive Outpatient Program (IOP) None of the above Select all that apply BACK Have you ever attempted suicide before? Yes No BACK When did your last suicide attempt occur? Within the last 12 months 1-5 years ago 6-10 years ago More than 10 years ago BACK Have any of these happened to you in the past six months? Went to the emergency room for a mental health issue Went to the emergency room for a substance use issue Had an inpatient facility stay for a mental health issue Had an inpatient facility stay for a substance use issue None of the above Select all that apply BACK Create your free accountLet's set up your account so you can securely access your results.Email* HiddenPHQ-9 ScoreHiddenGAD-7 Score hidden Mental Health Assessment "*" indicates required fields Step 1 of 24 4% First, who needs care? Please enter your name, or the name of the person who will receive care. This will be kept confidential. First name* Zip code* Platinum Psychiatry is a fully remote service, but US law requires providers to be certified in the patient's state of residence. BACK What is {First name:1}'s age? Less than 13 years old Between 13 and 17 years old Between 18 and 64 years old 65 years or older BACK In the past 2 weeks, how often have you experienced the following?Little interest or pleasure in doing things. Nearly every day More than half of days Several days Not at all BACK In the past 2 weeks, how often have you experienced the following?Feeling down, depressed, or hopeless. Nearly every day More than half of days Several days Not at all BACK In the past 2 weeks, how often have you experienced the following?Trouble falling or staying asleep, or sleeping too much. Nearly every day More than half of days Several days Not at all BACK In the past 2 weeks, how often have you experienced the following?Feeling tired or having little energy. Nearly every day More than half of days Several days Not at all BACK In the past 2 weeks, how often have you experienced the following?Feeling bad about yourself - or that you are a failure or have let yourself or your family down. Nearly every day More than half of days Several days Not at all BACK In the past 2 weeks, how often have you experienced the following?Trouble concentrating on things, such as reading the news or watching television. Nearly every day More than half of days Several days Not at all BACK In the past 2 weeks, how often have you experienced the following?Moving or speaking slowly that other people have noticed. Or the opposite - being so restless or fidgety that you have been moving around a lot more than usual. Nearly every day More than half of days Several days Not at all BACK In the past 2 weeks, how often have you experienced the following?Thought that you would be better off dead, or of hurting yourself in some way. Nearly every day More than half of days Several days Not at all BACK How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? Extremely difficult Very difficult Somewhat difficult Not difficult at all BACK Over the past 2 weeks, how often have you been bothered by the following problems?Feeling nervous, anxious, or on edge. Nearly every day More than half of days Several days Not at all BACK Over the past 2 weeks, how often have you been bothered by the following problems?Not being able to stop or control worrying. Nearly every day More than half of days Several days Not at all BACK Over the past 2 weeks, how often have you been bothered by the following problems?Worrying too much about different things. Nearly every day More than half of days Several days Not at all BACK Over the past 2 weeks, how often have you been bothered by the following problems?Having trouble relaxing. Nearly every day More than half of days Several days Not at all BACK Over the past 2 weeks, how often have you been bothered by the following problems?Being so restless that it is hard to sit still. Nearly every day More than half of days Several days Not at all BACK Over the past 2 weeks, how often have you been bothered by the following problems?Becoming easily annoyed or irritable. Nearly every day More than half of days Several days Not at all BACK Over the past 2 weeks, how often have you been bothered by the following problems?Feeling afraid as if something awful might happen. Nearly every day More than half of days Several days Not at all BACK Have you tried anxiety or depression treatment before? Yes No BACK What type of treatment have you tried? Therapy Psychiatry/medication Primary care Hospitalization or Partial Hospitalization Program (PHP) Intensive Outpatient Program (IOP) None of the above Select all that apply BACK Have you ever attempted suicide before? Yes No BACK When did your last suicide attempt occur? Within the last 12 months 1-5 years ago 6-10 years ago More than 10 years ago BACK Have any of these happened to you in the past six months? Went to the emergency room for a mental health issue Went to the emergency room for a substance use issue Had an inpatient facility stay for a mental health issue Had an inpatient facility stay for a substance use issue None of the above Select all that apply BACK Create your free account, let's set up your account so you can securely access your results.Email* HiddenPHQ-9 ScoreHiddenGAD-7 Score hidden
