This form is not a diagnostic instrument and is only to be used within the context of your medical treatment and by you if you are greater than 18 years old. Share your checklist responses and assessment with your physician or other health care provider. The maker and provider of this form disclaims any liability, loss, or risk incurred as a consequence, directly or indirectly, from the use and application of any of this material.

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About the M3 Screen

What is the purpose of the M3 Screen?

The online M3 Screen is a private, self-rated checklist for potential mood and anxiety symptoms. Your checklist responses trigger a risk assessment page indicating your relative risk for depression, an anxiety disorder, bipolar disorder and post-traumatic stress disorder (PTSD). The Screen responses and the resulting M3 risk assessment may be printed, faxed, emailed or securely accessed online by a designated health care professional, all at the discretion of the user. The information provided by the M3 expedites and organizes a discussion between doctor and patient of relevant mental health issues at their next office visit, helping to direct the physician toward a more accurate diagnosis. By providing parallel educational material for patients and their physicians the M3 encourages treatment compliance and long-range follow-up of progress.

Who benefits from completing the M3 online?

Anyone 18 years and older may complete the online M3 Screen. Patients will benefit by being directed toward a more accurate diagnosis and more appropriate treatment. Physicians benefit from the M3 because poorly treated mood and anxiety disorders impede compliance with medical treatments and adversely affect recovery from illness and physical health generally. Within the tight time constraints of a typical office visit, the M3 provides physicians with a highly effective tool for eliciting and organizing the mood and anxiety symptoms that may be interfering with their patients’ lives.

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This form is not a diagnostic instrument and is to be used solely within the context of your medical treatment with your physician or other health care provider. The maker and provider of this form disclaims any liability, loss, or risk incurred as a consequence, directly or indirectly, from the use and application of any of this material. WhatsMyM3™ V.03.06 Copyright © 2002-2012 by M3 Information™, The M-3 Checklist and WhatsMyM3.com are free for personal home use. For any other uses, including clinical., educational, non-profit, hospital research, or for-profit settings please contact mail@m-3information.com. No further reproduction or distribution, or reverse engineering is permitted without written permission from M3 Information. Patent Pending.