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Measures and Forms

Behavioral Health Measures

Your healthcare provider at Inspired Psychiatric Care may occasionally ask you to complete specific behavioral health measures to get more specific about your condition. Please do not submit a form unless asked to do so by your provider.

Administrative Forms

You can use these forms to update your credit card information or insurance information. You can also use Consent to Release Information if you want IPC to share your information with a non-IPC provider, practice, hospital or inpatient clinic. Your provider may also ask you to complete the Controlled Substance Agreement in some cases.

Behavioral Health Measures

Abnormal Involuntary Movement Scale (AIM)	https://intakeq.com/new/8BpFCG/n1gsif
Adult ADHD Self-Report Scale Symptom Checklist	https://intakeq.com/new/8BpFCG/e4gram
Adverse Childhood Experience (ACE)	https://intakeq.com/new/8BpFCG/kvibhm
Alcohol Use Disorders Identification Test	https://intakeq.com/new/8BpFCG/n1gsif
Beck Anxiety Inventory (BAI)	https://intakeq.com/new/e0A5G6/alat1q
Beck Depression Inventory	https://intakeq.com/new/8BpFCG/l6lt8g
Beck Hopelessness Scale	https://intakeq.com/new/e0A5G6/fwxinh
Brief Psychiatric Rating Scale	https://intakeq.com/new/8BpFCG/b4g0og
CAGE-AID Adapted to Include Drugs	https://intakeq.com/new/8BpFCG/3lgj0r
Clinical Opiate Withdrawal Scale	https://intakeq.com/new/bdxy0f/3lgj0r
EMDR Dissociative Experiences Scale	https://intakeq.com/new/e0A5G6/e1ta1v
Endinburgh Postnatal Depression Scale (EPDS)	https://intakeq.com/new/e0A5G6/rc16wz
Geriatric Depression Scale (Long Form)	https://intakeq.com/new/e0A5G6/wiiesh
Geriatric Depression Scale (Short Form)	https://intakeq.com/new/e0A5G6/thpu9x
Mood Disorder Questionnaire	https://intakeq.com/new/e0A5G6/wdnekb
OCD Screen	https://intakeq.com/new/e0A5G6/mpfwfa
Post-Traumatic Stress Disorder Checklist – Specific	https://intakeq.com/new/e0A5G6/ev9wji
SCID Major Depressive Episode Screen	https://intakeq.com/new/e0A5G6/rypjbp
SCID Manic Episode Screen	https://intakeq.com/new/e0A5G6/zf9ao6
*Suicide Ideation Intensity	https://intakeq.com/new/e0A5G6/q2fbj3
Trauma Questionnaire	https://intakeq.com/new/e0A5G6/vsj4e6
Vanderbilt ADHD Parent Rating Scale	https://intakeq.com/new/e0A5G6/qjw3uq
Vanderbilt ADHD Teacher Rating Scale	https://intakeq.com/new/e0A5G6/exbdkx

Administrative Forms

Consent to Release Information	https://intakeq.com/new/8BpFCG/t7rle0
Credit Card on File Consent Form	https://intakeq.com/new/e0A5G6/ytnfag
Insurance Information Update	https://intakeq.com/new/e0A5G6/wiiesh
Controlled Substance Agreement	https://intakeq.com/new/e0A5G6/oudged

Documents Available to Download/View

• Inspired Psychiatric Care Privacy Practices (PDF)
• Website Privacy Practices