Full Name
*
Email
*
Phone
Over the past 2 weeks, how often have you felt down, depressed, or hopeless?
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Not at all
Several days
More than half the days
Nearly every day
How often have you experienced excessive worry, nervousness, or restlessness?
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Not at all
Several days
More than half the days
Nearly every day
How often do you have trouble focusing, remembering, or completing tasks?
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Not at all
Several days
More than half the days
Nearly every day
How often have you felt overwhelmed by stress, daily demands, or life events?
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Not at all
Several Days
More than half the days
Nearly every day
Have you found yourself sleeping too much or too little, or experiencing disrupted sleep?
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Not at all
Several Days
More than half the days
Nearly every day
Have you lost interest in things you used to enjoy?
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Not at all
Several Days
More than half the days
Nearly every day
How often have others expressed concern about your mood, energy, or behavior?
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Not at all
Several Days
More than half the days
Nearly every day
