“Support Doesn't End When the Appointment Ends.”

Member Support Check-In

Welcome.

Please complete only the form(s) that apply to your current needs.

Most members will only need one form at a time.

If you are unsure where to begin, start with the Weekly Wellness

Check-In.

🚨 Crisis Support Notice

This is not an emergency service.

If you are in crisis, call or text 988, call 911, or go to your nearest emergency room.

Description of Form’s Contents:

Weekly Check in:

General updates regarding mood, stress, sleep, appetite, energy, and overall well-being.

Anxiety Screening: (GAD-7)

Complete this form if anxiety, worry, nervousness, panic symptoms, or stress are becoming difficult to manage.

Depression Screening: (PHQ-9)

Complete this form if you are experiencing sadness, low motivation, loss of interest, or depressive symptoms.

Medication Experience Check-In:

Complete this form if you have medication questions, refill concerns, side effects, or treatment-related issues.

Support Request & Emotional Check-In:

Complete this form if you would like additional support, have concerns not covered elsewhere, or would like office follow-up.