Patient Forms

Please take a moment and print the forms below pertaining to your situation prior to arriving to your appointment.

Anxiety pdf. Form

List of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you
have been bothered by that symptom during the past month, including today, by circling the number in the
corresponding space in the column next to each symptom.

Depression pdf. Form

This depression inventory can be self-scored. The scoring scale is at the end of the questionnaire.

Obsessive Compulsive Scale pdf.

This rating scale is designed to rate the severity and type of symptoms in patients with obsessive compulsive
disorder (OCD). In general, the items depend on the patient’s report; however, the final rating is based on the
clinical judgment of the interviewer. Rate the characteristics of each item during the prior week up until and
including the time of the interview. Scores should reflect the average (mean) occurrence of each item for the
entire week.


Family Therapy
Adult Psychiatry
Children/Adolescent Psychiatry
Mental & Behavioral Health
Stress Management


(813) 931-7022
Dr. Jessica G. Rausch, MD.
14502 N Dale Mabry Hwy Ste 328, Tampa, Florida, 33618

Find Out If We Are A Good Fit.

I offer group as well as individual counseling for the client.

I aim to assist you in restoring your emotional and behavioral balance in your life.


Is It Time For You To Make A Change?

There is hope for all, regardless of the emotional situation you find yourself in - from a temporary crisis, inappropriate behaviors resulting from past hurts, and relationships that don't support your well-being. We work to help you become empowered in your life.