Book A Consultation
Call Us

Please fill below details.

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

Question Not at all Several days More than half the day Nearly everyday
a. Little interest or pleasure in doing things.
b. Feeling down, depressed, or hopeless
c. Trouble falling/staying asleep, sleeping too much.
d. Feeling tired or having little energy.
e. Poor appetite or overeating.
f. Feeling bad about yourself or that you are a failure or have let yourself or your family down.
g. Trouble concentrating on things, such as reading the newspaper or watching television.
h. 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.
i. Thoughts that you would be better off dead or of hurting yourself in some way.
Not difficult at all Some what difficult Very difficult Extremly Difficult
2. If you checked off any problem on this questionnaire so far, 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?