Schedule an Appointment

Prior to your first appointment, we ask that you complete as many of the following forms as you can. These will help make the evaluation process more efficient and accurate and help make your experience more rewarding. 

Patient Information (fill out this form)
This form is required for all new patients. This gives Dr. Pundy all the necessary personal and medical information required before any treatments begin.

Medication Review (fill out this form)
This short form asks you to review a list of medications and note whether you have taken them in the past, the length of the treatment, and results of the medication. This gives Dr. Pundy the opportunity to review and discuss the medications that you have taken.

MINI International Neuropsychiatric Interview (fill out this form)
This “mini” psychological screening test is used to assess psychopathologic status and personality functioning. Dr. Pundy combines these test results with information gathered from the history, clinical evaluation, and other tests to assess your emotional, behavioral, and psychiatric needs.

Mood Disorder Questionnaire (fill out this form)
This is a quick, 1-page, yes/no questionnaire that asks you whether you have ever experienced particular moods or behaviors for a period of time.

Patient Health Questionnaire (PHQ-9) (fill out this form)
This is a 9-item health questionnaire asking you whether you have experienced certain problems over the past two weeks. Dr. Pundy will use this test to assess your symptoms and how much they impair your functioning.

Quick Inventory of Depressive Symptomatology (QIDS) (fill out this form)
This 16-item form asks you to rate the difficulty or frequency of certain activities or moods, such as whether you have trouble falling asleep or have experienced changes in appetite. These questions are designed to assess the severity of depressive symptoms.

Symptom Checklist 90 (SCL-90) (fill out this form)
In this form, you are asked how much you are bothered by certain feelings, symptoms, or behaviors, such as headaches, loneliness, feelings of guilt, and disturbed sleep. This checklist is designed to evaluate a broad range of psychological problems and symptoms.

Social History (fill out this form)
This is a detailed questionnaire that asks about various stages and interactions in your life, including your family and developmental history, education, financial history and status, employment history, alcohol and drug history, medical history, and family life. Your social history assists Dr. Pundy in obtaining information that will be useful in diagnosing and treating your psychiatric needs as well as giving clues as to the cause of any symptoms or behaviors.

Temperament Questionnaire (TEMPS-A) (fill out this form)
This quick questionnaire helps tell Dr. Pundy what type of person you are. Simply answer “yes” or “no” to each description of a personality trait or temperament, such as “I am the kind of person who likes to be the boss.

Adult Self-Report Scale Symptom Checklist (ASRS) (fill out this form)
This short test asks you whether you have had any particular problems with your job or at school over the past six months.

 

*** These tests are for screening purposes only. They are designed to give a preliminary indication psychopathologic status and personality functioning. Though they may help increase your awareness of particular experiences or of particular forms of psychological distress, they are not, by themselves, tools for diagnosing any type of health or mental health condition. Online tests do not replace an evaluation by a trained psychiatrist such as Dr. Pundy.

If you are suicidal, call 911 or go to the nearest emergency room.