Depression Review

This field is for validation purposes and should be left unchanged.
Date of Birth  Required

Mental Health Review

Over the last 2 weeks, how often have you been bothered by any of the following problems?
Little interest or pleasure in doing things  Required
Feeling down, depressed, or hopeless  Required
Trouble falling or staying asleep, or sleeping too much  Required
Feeling tired or having little energy  Required
Poor appetite or overeating  Required
Feeling bad about yourself — or that you are a failure or have let yourself or your family down  Required
Trouble concentrating on things, such as reading the newspaper or watching television  Required
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  Required
Thoughts that you would be better off dead or of hurting yourself in some way  Required
If you checked off any problems, 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?  Required