AutoPsych Med-Check

AutoPsych Med-Check

Welcome back! Let's get started.
Please Verify Your Information
Are you an AutoPsych member?*

YesNo
Please Verify Your Name*

First NameLast Name
Please Verify Your Date of Birth*

MonthDayYear
Date
Please Verify Your Current Phone Number*
Please enter a valid phone number.
Verify your email address*
example@example.com
Now, Let's Enter Some Visit Information
What's the reason for your visit today?*

Regular consultI would like to adjust/change my medsOther
Any problems today?*

All goodNot so good, I need to speak with someone right awayOther
Are we making any progress?*

Lots of progressSome progressAbout the sameWorseOther
Any medication side effects?*

None at allYes, but they're mild and tolerable and I'm not worriedYes, they're severe, I'm worried, and I need to speak with a provider right away
Blood pressure*

NormalAbnormal
Resting heart rate*

NormalAbnormal
Blood Pressure and Heart Rate Measurement Information and Guidelines
Current weight (lbs)*
Current height (in)*
Let's Check on a Few Things
Please select any that apply to you:*

I feel fineI am having trouble focusing and getting things doneI am having difficulty staying calmI'm not sleeping wellOther
Calmness Screener*

1

2

3

4

5

1 is Super calm, 5 is Always stressed no matter what
Focus Screener *

1

2

3

4

5

1 is Laser focused, 5 is Can't focus at all
Sleep Screener*

1

2

3

4

5

1 is I sleep great , 5 is I can't sleep at all
Depression Screener*

1

2

3

4

5

1 is Content, not depressed at all, 5 is Very depressed
Freestyle. Tell us anything, always private, always secure, we're here to help. FYI. This is a great place to clarify any requests for changes to your medications. If you would like to change medications, please let us know things like the name, dose, and frequency you might prefer, so we can help make the best clinical decisions on your behalf.
Okay thanks! Let's wrap this up.

Please select your follow up preference, preferred pharmacy, and contact preference.
How would you prefer to check in next time?*

AutoPsych(like this)Live visit with an AutoPsych providerOther
Please verify your preferred Pharmacy*

Same as last timeOther
May we contact you by email and text to communicate care updates with you?*

YesNo
Signature:*

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How are we doing?

I LOVE it hereIt's okayThis place is the worstOther
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AutoPsych Med-Check

Please Verify Your Information

Now, Let's Enter Some Visit Information

Let's Check on a Few Things

Okay thanks! Let's wrap this up.