We just have a few more questions

This short survey will only take a minute and will help us better understand the emotional challenges you are experiencing.

Please check the answer that comes closest to how you have felt IN THE PAST 2 WEEKS, not just how you feel today. Over the past 2 weeks, how often have you been bothered by any of the following problems?

Little interest or pleasure in doing things*

Not at all
Several Days
More than half the days
Nearly every day

Feeling down, depressed or hopeless*

Not at all
Several Days
More than half the days
Nearly every day

Trouble falling asleep, staying asleep, or sleeping too much*

Not at all
Several Days
More than half the days
Nearly every day

Feeling tired or having little energy*

Not at all
Several Days
More than half the days
Nearly every day

Poor appetite or overeating*

Not at all
Several Days
More than half the days
Nearly every day

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

Not at all
Several Days
More than half the days
Nearly every day

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

Not at all
Several Days
More than half the days
Nearly every day

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*

Not at all
Several Days
More than half the days
Nearly every day

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

Not at all
Several Days
More than half the days
Nearly every day

Hidden

Score

Hidden

location

Hidden

Provider

Hidden

Escalate

Hidden

Severe Depression

Hidden

Suicidal Thoughts

Hidden

MRN

Hidden

status

Hidden

Pmobile