We’ve changed names! Equilibrium Behavioral Health is NOW Omi Psychiatry & TMS

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Who We Treat
What We Treat
- Depression
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Self-Assessment Form

The following Patient Health Questionnaire is a multipurpose self-assessment to assist your physician in screening, diagnosing, and measuring the severity of depression.

Name *

First

Last

Date of Birth *

Phone Number *

Address

Over the last two weeks, how often have you been bothered by any of the following problems?

.

1. Little interest or pleasure in doing things

0 - Not at all
1 - Several days
2 - More than half the days
3 - Nearly every day

2. Feeling down, depressed, or hopeless

0 - Not at all
1 - Several days
2 - More than half the days
3 - Nearly every day

3. Trouble falling or staying asleep, or sleeping too much

0 - Not at all
1 - Several days
2 - More than half the days
3 - Nearly every day

4. Feeling tired or having little energy

0 - Not at all
1 - Several days
2 - More than half the days
3 - Nearly every day

5. Poor appetite or overeating

0 - Not at all
1 - Several days
2 - More than half the days
3 - Nearly every day

6. Feeling bad about yourself – or that you are a failure or have let yourself or your family down

0 - Not at all
1 - Several days
2 - More than half the days
3 - Nearly every day

7. Trouble concentrating on things, such as reading the newspaper or watching television

0 - Not at all
1 - Several days
2 - More than half the days
3 - Nearly every day

8. Moving or speaking so slowly that other people could notice. Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual

0 - Not at all
1 - Several days
2 - More than half the days
3 - Nearly every day

9. Thoughts that you would be better off dead, or of hurting yourself

0 - Not at all
1 - Several days
2 - More than half the days
3 - Nearly every day

Would you be interested in learning about NeuroStar TMS, an FDA-cleared, non-drug treatment option that has been proven effective for people with depression?

Yes
No

How many anti-depressant prescription medications do you currently take or have tried in the past?

0
1
2-4
5+
Not Sure

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Learn More

Treatment Services

Contact



2700 Lighthouse Point East

Baltimore, MD 21224



info@omipsychiatry.com

© 2023 Omi Psychiatry & TMS. All Rights Reserved. Privacy Policy Privacy Notice Web Dev

<img decoding="async" width="805" height="261" src="https://omipsychiatry.com/wp-content/uploads/2022/11/logo-psychology-today.png" alt="" title="" srcset="https://omipsychiatry.com/wp-content/uploads/2022/11/logo-psychology-today.png 805w, https://omipsychiatry.com/wp-content/uploads/2022/11/logo-psychology-today-480x156.png 480w" sizes="(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) 805px, 100vw" class="wp-image-458" />

Learn More

Treatment Services

Contact Us



2700 Lighthouse Point East,

Suite 260

Baltimore, MD 21224



info@omipsychiatry.com



© 2023 Omi Psychiatry & TMS. All Rights Reserved.

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