• A copy of your results will be sent to you and to our Help Specialist. Should your score indicate you are depressed, we may contact you to discuss available options.

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  •  -

  • The following questionnaire consists of 7 statements. Please read each group of statements carefully, and then pick out the one statement in each group that best describes the way you have been feeling during the past two weeks, including today. If several statements in the group seem to apply equally well, select the highest number for that group.

  • Over the last 2 weeks, how often have you been bothered by any of the following problems?*
    Rows
  • Over the last 2 weeks, how often have you been bothered by any of the following problems?*
    Rows
  • If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?*
    Rows
  • Should be Empty: