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Sunil N. Lalla, M.D. PA, Bharti Lalla, M.D. FAAP
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CHILDREN Annual depression screening PHQ 9 (Children < 18 years)
CHILDREN Registration form Dr Bharti Lalla (New Patient)
CHILDREN Sports Physical Form
CHILDREN Telemedicine Patient Consent Form (Dr Bharti Lalla Children ONLY)
CHILDREN Tuberculosis Questionnaire (Children < 18 years)
Consent for Paxlovid
Doximity telehealth Instructions
Six min WALK
zADULT Depression screen and Fall Risk Assessment
zADULT Telemedicine Patient Consent Form (Dr Sunil Lalla patients)
ADULT Medical History (New Patient) Dr. Sunil Lalla
ADULT Sleep History (Dr. Sunil Lalla)
ADULT Registration form Dr S Lalla (New Patient)
CHILDREN Annual depression screening PHQ 9 (Children < 18 years)
Bharti Lalla MD PA
First Name
*
Last Name
*
Date of Birth
*
Date of Completion
*
New Field17
Little interest or pleasure in doing things
*
-- Please Select --
Not at all (0)
Several Days (1)
More than half the days (2)
Nearly every day (3)
Feeling down, depressed or hopeless
*
-- Please Select --
Not at all (0)
Several Days (1)
More than half the days (2)
Nearly every day (3)
Trouble falling or staying asleep or sleeping too much.
*
-- Please Select --
Not at all (0)
Several Days (1)
More than half the days (2)
Nearly every day (3)
Feeling tired or having little energy.
*
-- Please Select --
Not at all (0)
Several Days (1)
More than half the days (2)
Nearly every day (3)
Poor appetite or overeating.
*
-- Please Select --
Not at all (0)
Several Days (1)
More than half the days (2)
Nearly every day (3)
Feeling bad about yourself or that you are a failure or have let yourself or family down.
*
-- Please Select --
Not at all (0)
Several Days (1)
More than half the days (2)
Nearly every day (3)
Trouble concentration on things such as reading the newspaper or watching TV.
*
-- Please Select --
Not at all (0)
Several Days (1)
More than half the days (2)
Nearly every day (3)
Moving or speaking so slowly that other people could have noticed. Or the opposite being so fidgety or restless that you have been moving around a lot more than usual.
*
-- Please Select --
Not at all (0)
Several Days (1)
More than half the days (2)
Nearly every day (3)
Thoughts that you would be better off dead or of hurting yourself in some way.
*
-- Please Select --
Not at all (0)
Several Days (1)
More than half the days (2)
Nearly every day (3)
* Required field
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