Can TMS treatment help you?
Pinnacle Behavioral Health IPA, LLC
1 Pinnacle Place, Albany, NY 12203 (518) 508-4TMS (867)
Over the last 2 weeks, how often have you been bothered by any of the following problems?
*
Not at all
Several Days
More than half the days
Nearly Every Day
1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or sleeping too
much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself — or that you are a
failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading
the newspaper or watching television
8. Moving or speaking so slowly that other people
could have noticed? Or the opposite — being so
fidgety or restless that you have been moving
around a lot more than usual
9. Thoughts that you would be better off dead or of
hurting yourself in some way
Total Score
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?
*
Not difficult at all
Somewhat difficult
Very difficult
Extremely difficult
Name:
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First Name
Last Name
Date of Birth
*
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Month
/
Day
Year
Date
Today's Date
*
/
Month
/
Day
Year
Date
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Submit
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