UWIntake – Tumbleweed Health Services

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Clients Name

Clients Date of Birth

What brings you to Tumbleweed Health Services today? How can we help0 / 180

Mental Health History

Safety Screening

If you are currently experiencing a mental health crisis please reach out to the following supports: Saskatchewan: 9-8-8 Suicide Crisis Helpline. In Canada: Crisis Services Hotline – 24 hour, immediate connection with a counsellor (English + French) – 1-833-456-4566

Over the past two weeks have you experienced little interest or pleasure in doing things?0 – Not at all1 – Several Days2 – More than half the days3 – Nearly every dayPHQ-2

Over the past two weeks have you experienced feeling down, depressed, or hopeless?0 – Not at all1 – Several Days2 – More than half the days3 – Nearly every dayPHQ-2

In the past two weeks, have you had thoughts of self-harm or suicide?YesNo

Are you aware that Dr. Matiza operates as a private-pay service and does not bill Saskatchewan Health? *

Apply Now

Safety Screening

If you are currently experiencing a mental health crisis please reach out to the following supports: Saskatchewan: 9-8-8 Suicide Crisis Helpline. In Canada: Crisis Services Hotline – 24 hour, immediate connection with a counsellor (English + French) – 1-833-456-4566