Patient Health Questionnaire (PHQ-9)

 

ATTENTION - PLEASE READ


StarCare Specialty Health System does not prescribe stimulants (including but not limited to Adderall, Vyvanse, Ritalin) or benzodiazepines (including but not limited to Xanax, Klonopin, Valium, Ativan).


Medication management resources outside of StarCare can be found by calling 211 Texas (dial 2-1-1) or visit their website at https://www.211texas.org.

 

If you are experiencing a mental health crisis, call 806-740-1414 or 800-687-7581.

 

 

StarCare Specialty Health System takes all necessary steps to ensure Health Insurance Portability and Accountability Act (HIPAA) compliance. For more information, click the "Privacy Notice" link at the bottom of this form.

 

 

Instructions for Completing Intake Forms

Complete the following information for the person seeking services with StarCare Specialty Health System.


Completing this information ahead of time will shorten the time needed to complete your intake. Upon completion of the intake process, if eligible, you will be authorized for services based on your need. You will be assigned a case manager to assist you with accessing needed resources and services.

 

 
 
 
 
 
 
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Over the last 2 weeks, how often have you been bothered by any of the following problems? For each question, please select the answer that most applies to you.

 
 
 
 
 
 
 
 
 
 

 

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?

 
 

 

By typing my full name below, I certify the information provided is true and complete to the best of my knowledge. I understand typing my name is a legal signature and is considered the same as my handwritten signature.

 
 
 
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