This short survey will take 10-20 minutes to complete.
Once you begin your survey keep track of how far along you are with the progress bar in the upper right corner. You may stop this survey at any time by clicking "Exit" at the top right corner of the screen. You can skip any question you do not feel comfortable answering. If there is a question that you would like your clinician to focus on during your appointment, please check the "Further Discussion" box on that item.
By clicking on the "Agree" button below, you are acknowledging that you are at least 18 years of age and that you agree that Health Outcomes, Inc. dba TeleSage, as well as its sponsors, partners, and advertisers disclaim any liability for loss, or other adverse events that might occur as a consequence, directly or indirectly, from the use or misuse of this survey or from reading, using, or transmitting the associated report.
You are also acknowledging that this survey is not to be used as a diagnostic tool.
A report based on your answers to the questions will appear at the end of this survey. You can download the report and give it to your clinician, or you can print it. Once you leave the report page, the electronic report will no longer be accessible. You are encouraged to share your results with your physician or healthcare provider.
If you have any immediate concerns about your physical or emotional health, please consult a physician or other health care provider directly.