Schedule Appointment for Serenity Clinic

Request an Appointment with Serenity Clinic

**Appointment times are not final until you receive a confirmation email**
Name*

First NameLast Name
Phone Number*
E-mail*
example@example.com
First Time Visit? If yes, select a one hour appointment*

YesNo
What state do you live in?*

ColoradoConnecticutFloridaIllinoisIowaKansasMaineMinnesotaMissouriNebraskaNew HampshireNew MexicoNew YorkOhioRhode IslandSouth DakotaTennesseeTexasVirginiaWest VirginiaOther

PHQ -9*

	Not at all - 0 Several days - 1 More than half days - 2 Nearly every day -3
Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Trouble falling or staying asleep, or sleeping too much
Feeling tired or having little interest
Poor appetite or overeating
Feeling bad about yourself - or that you are a failure or have Let yourself or your family down
Trouble concentrating on things, such as reading the newspaper or watching television
Moving or speaking so slowly that other people could have noticed. Or the opposite - being so figety or restless that your have been moving around a lot more than usual
Though that you would be better off dead, or of hurting yourself

If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?

GAD - 7*

	Not at all - 0 Several days - 1 More than half days - 2 Nearly every day -3
Feeling nervous, anxious, or on edge
Not being able to stop or control worrying
Worrying too much about different things
Trouble relaxing
Being so restless that it’;s hard to sit still
Becoming easily annoyed or irritable
Feeling afraid as if something awful might happen

Request an Appointment with Serenity Clinic