Completing this form initiates contact with a member of the treatment team; you will receive a confirmation email verifying your request for screening measures. A member of the treatment team will review the request and send you an email with the full-length screening measures; these include brief screening measures for problematic opioid use, affective distress, depressive symptoms, and pain-related functional disability. These screening measures require only a few minutes for patients to complete. Additionally, a PDF file with scoring instructions for all measures will be also be sent with the screening measures. The scoring instructions document also includes reference ranges for patient scores suggestive of the need for potential referral. The “Score Summary” on page 3 of this document is intended to help determine whether a patient’s set of scores warrant referral.
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Screening Tools 
