• Mental Health Questionnaire

  • Date*
     - -
  • Rows
  • If you checked off any problems, how difficult have those problems made it for you to do your work, take care of things at home, or get along with other people?*
  • Rows

  • Please read each statement and mark a number 0, 1, 2, or 3 which indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement.

    The rating scale is as follows:

    0: Did not apply to me at all - NEVER

    1: Applied to me to some degree, or some of the time - SOMETIMES

    2: Applied to me to a considerable degree, or a good part of the time - OFTEN

    3: Applied to me very much, or most of the time - ALMOST ALWAYS

  • Rows
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