• Demographics

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    Pick a Date
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    Pick a Date
  • Ann Arbor Psychiatry Automated Clinical Interview

  • Welcome to Ann Arbor Psychiatry! 

    This virtual clinical interview will adapt itself as you go based on your answers to questions.

    • It is a bit of a marathon. Feel free to pace yourself and skip any optional questions that don't speak to you. You can always go back to previous pages.
    • Answers here will be reviewed by your clinician to make the best use of your time in the office.
    • If you have a laptop nearby, we STRONGLY recommend using it instead of a phone as it may be easier to type out lengthy answers by keyboard.
  • Insurance / Extended Demographics

  • Please be sure of your answer to the following question about if we have your insurance information. We have to delete intake appointments without this information, as we do not always have a receptionist on hand to take the information in the office.

  • History of Psychiatric Treatment

  • Goals

  • It's a long intake form and the symptom focused questions are most important, so feel free to skip anything listed as optional unless you have the time and stamina!

  • HIPAA

    The best care is delivered when all of your clinicians are in communication with one another. We send our intake evaluation to PCPs and therapists whenever possible so everyone is on the same page.
  • ADHD


  • Anxiety



  • Depression

  • Mania

  • OCD

  • Lashing Out / Anger

  • Medical Issues

  • Social History

  • Optional: Tell us about yourself. 

    Were you raised by one or two parents? Biological or Adopted?

    Any difficult or unusual aspects of childhood? Divorce? Moves? Bullying?

    Physical or sexual abuse of any kind?

    How far did you go in school?

    Who do you live with? How do you currently pay the bills? 

     

  • Psychological

  • Substances Abuse

  • Clinic Policies

  • Clear
  • Should be Empty: