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Questionnaire Packet

To monitor our patients’ progress, we advise patients to please fill out these forms at least once or twice a week.

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Burns Anxiety Inventory (BAI)

BAI is an assessment tool used to measure anxiety and can be self-administered or administered by a clinician.

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Generalized Anxiety Disorder 7 (GAD-7)

It is a self-reported questionnaire for screening and severity measuring of generalized anxiety disorder (GAD). 

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CAGE Questionnaire

Named of which is an acronym of its four questions, CAGE is a widely used method of screening for alcoholism.

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Australian Scale for Aspergers Syndrome

Designed to identify behaviours and abilities indicative of Asperger’s Syndrome in children during primary school years.

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Quick Inventory of Depressive Symptomatology

Can be used to screen for depression, although they have been used predominantly as measures of symptom severity.

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Geriatric Depression Scale Short Form (GDS-SF)

15-item screening tool used to identify depression in older adults. Used with healthy, medically ill and mild to moderately cognitively impaired adults.

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Primary Care PTSD Screen (PC-PTSD)

The PC-PTSD is a 4-item screen that was designed for use in primary care and other medical settings and is currently used to screen for PTSD in veterans at the VA.

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Patient Health Questionnaire-9 (PHQ-9)

The PHQ-9 is the nine item depression scale of the Patient Health Questionnaire. The PHQ-9 assists primary care clinicians in diagnosing depression and selecting treatment.

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Hamilton Rating Scale for Depression (HAM-D)

The questionnaire rates the severity of symptoms observed in depression such as insomnia, anxiety and weight loss.

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Arizona Sexual Experiences Scale (ASEX)

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Pain Management Patient Questionnaire

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Panic Disorder Severity Scale Self-Report (PDSS)

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MDQ (Mood Disorder Questionnaire)

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ASRS (ADHD Screen)

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YBOCS (Yale Brown Obsessive-Compulsive Scale)

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MADRS (Montgomery Asberg Depression Rating Scale)

Please note: These forms are in Portable Document Format (pdf) and require a pdf reader. If your computer does not have a pdf reader, you may download Adobe Reader X for free here.
Reader X download note: The download is preset to automatically include, for free, both the Google Chrome Internet Browser and the Google Toolbar for Internet Explorer.

These are optional and are NOT required to view and/or print Integrated Clinical Neurosciences/Silicon Valley TMS forms. If you do NOT want them included in your download, be sure to CLEAR the check box called “Yes, install Chrome as my default browser and Google Toolbar for Internet Explorer – optional.(32.11 MB)”.

In Network With
United Healhcare
Anthem - BlueCross
MHN - A Health Net Company
Magellan Health Insurances


Our practice has officially closed on Friday, January 20, 2023. It has been our privilege to have had the opportunity to meet the healthcare needs for individuals throughout the community.

In California, since the passage of SB-221 which went into effect starting July 2022, health plans and insurances are required to provide timely access to care including follow up appointments for primary care and specialist appointments as well as for other mental health follow-up appointments within 10-15 days. Information is also available at the following link: