Patient questionnaires and checklists
Forms
For Dr. Locke’s New or Continuing Patients As we have agreed to work together, there are a number of routine forms I will need you to fill out and/or read. For your convenience, we have combined these routine new-patient forms into a single PDF, the “New-Patient Forms Package” that appears below.* From time to time, various other specific forms, also below, may be helpful in our assessment. I look forward to working with you. For Other Situations (those who are not currently patients) I am pleased to be able to make available to you these questionnaires and forms that may help you to describe your symptoms to your current clinician (primary care doctor or behavioral health specialist). However, it’s important to understand that by making these forms available to you so that you can track your symptoms, they are not intended to be construed as beginning a formal doctor-patient relationship. They should only be used to provide structured information for another doctor who is already engaged in a doctor-patient relationship with you. *If at any stage you want to download individual components of that New-Patient Package, you can find the individual components here. SCHEDULE A Consultation NEW PATIENT FORMS PACKAGE A PDF that includes the several routine forms necessary for new patients.
HPPD Questionnaire
Questionnaire to Assess Persistent Visual Symptoms After Hallucinogen Use
Drug Abuse Screening Test
Rating Scale for Attention Deficit Hyperactivity Disorder
Wender Utah Rating Scale for Attention Deficit Hyperactivity Disorder
ADHD Severity Rating Scale (asrs)
Adult ADHD Self-Reporting Scale (ASRS-V1.1) Symptom Checklist