Hal S. Kopeikin, Ph.D.

Licensed Clinical Psychologist in Private Practice

Assessment & Office Forms

 
Client/Patient Intake form Clients complete this form before their first therapy session with me.  I'll have copies on hand, if you'd prefer to fill it out when we meet, but to get the most from our time together, bring a completed version with you.  For those of you with health insurance, it's ok to leave that section blank and bring your health insurance card to our meeting for me to photocopy.
Depression Screening Forms In conjunction with the Depression Treatment and Research Center, I provide free brief assessments of depression.  Here are relevant forms and questionnaires:
Depression Screening Overview and Intake Form
This form has two purposes:  It describes the consultation process, and collects basic client information.  I'll have copies on hand, if you'd prefer to fill it out when we meet, but to get the most from our time together, bring a completed version with you.
Depressive Symptom Questionnaire
This test will email your answers to me automatically, for use in our consultation.  It's designed to be completed while you're connected to the internet.
Here's a different, somewhat similar questionnaire for those who'd like to do a self-assessment (but remember the disclaimer).  It's a form you score by hand; the results are not transmitted to me.

Hal S. Kopeikin, Ph.D. (c) 2003