Full Name
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Email
*
Phone
Over the last 2 weeks, how often have you had little interest or pleasure in doing things?
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Not at all
Several days
More than half the days
Nearly every day
Over the last 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
Over the last 2 weeks, how often have you had trouble falling or staying asleep, or slept too much?
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Not at all
Several days
More than half the days
Nearly every day
Over the last 2 weeks, how often have you felt tired or had little energy?
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Not at all
Several Days
More than half the days
Nearly every day
Over the last 2 weeks, how often have you had poor appetite or overeating?
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Not at all
Several Days
More than half the days
Nearly every day
Over the last 2 weeks, how often have you felt bad about yourself — or that you are a failure or have let yourself or your family down?
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Not at all
Several Days
More than half the days
Nearly every day
Over the last 2 weeks, how often have you had trouble concentrating on things, such as reading or watching TV?
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Not at all
Several Days
More than half the days
Nearly every day
Over the last 2 weeks, how often have you been moving or speaking more slowly than usual? Or been so fidgety or restless that people noticed?
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Not at all
Several Days
More than half the days
Nearly every day
Over the last 2 weeks, how often have you had thoughts that you would be better off dead, or of hurting yourself?
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Not at all
Several Days
More than half the days
Nearly every day
