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Grassroot Psychiatry Mental Health Clinic
Take care of your health and happiness with us
Primary Menu
Home
About
Team
Services
Anxieties
Depression
Panic Attacks
ADHD
Psychosis
PTSD
Addictions
Substance Abuse
Bipolar Disorders
Mood Disorders
Schizophrenia
ODD & DSDM
Policies
Forms
Contact
Schizophrenia and Psychosis Questionnaire
Patient Name
*
Phone Number
*
Email Address
*
1. Do you ever hear or see things that others cannot?
*
Never
Rarely
Sometimes
Often
Very Often
2. Do you struggle to trust that what you are thinking is real?
*
Never
Rarely
Sometimes
Often
Very Often
3. Do you get the sense that others are controlling your thoughts and emotions?
*
Never
Rarely
Sometimes
Often
Very Often
4. Do you struggle to keep up with daily living tasks such as showering, changing clothes, paying bills, cleaning, cooking, etc.?
*
Never
Rarely
Sometimes
Often
Very Often
5. Do you feel that you have powers that other people cannot understand or appreciate?
*
Never
Rarely
Sometimes
Often
Very Often
6. Do you find it difficult to organize or keep track of your thinking?
*
Never
Rarely
Sometimes
Often
Very Often
7. Do other people say that it is difficult for you to stay on subject or for them to understand you? *
*
Never
Rarely
Sometimes
Often
Very Often
8. Are you struggling with maintaining social relationships, employment, and/or academic demands?
*
Never
Rarely
Sometimes
Often
Very Often
9. Do you feel that you are being tracked, followed, or watched at home or outside?
*
Never
Rarely
Sometimes
Often
Very Often
10. Do other people have a difficult time guessing your emotions by your facial expressions?
*
Never
Rarely
Sometimes
Often
Very Often
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Email
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