Depression Check-Up

First Name *

Last Name

Email *

Over the last 2 weeks, how often have you been bothered by the following problems?

0 - Not at all

1 - Several Days a week

2 - Over half the week

3 - Nearly every day

Little interest or pleasure in doing things *

0
1
2
3
No elements found. Consider changing the search query.
List is empty.

Feeling down, depressed, or hopeless *

0
1
2
3
No elements found. Consider changing the search query.
List is empty.

Trouble falling or staying asleep, or sleeping too much *

0
1
2
3
No elements found. Consider changing the search query.
List is empty.

Feeling tired or having little energy *

0
1
2
3
No elements found. Consider changing the search query.
List is empty.

Poor appetite or overeating *

0
1
2
3
No elements found. Consider changing the search query.
List is empty.

Feeling bad about yourself - that you are a failure or have let your family down *

0
1
2
3
No elements found. Consider changing the search query.
List is empty.

Trouble concentrating on things, such as reading the newspaper or watching TV *

0
1
2
3
No elements found. Consider changing the search query.
List is empty.

Moving or speaking so slowly that other people could have noticed? Speaking too fast? *

0
1
2
3
No elements found. Consider changing the search query.
List is empty.

Thoughts that you would be better off dead or of hurthing yourself in some way *

0
1
2
3
No elements found. Consider changing the search query.
List is empty.

Total Score

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