Mental Health Assessment Questionnaire
Please answer the following questions to help us understand your mental health status.
How often have you felt down, depressed, or hopeless in the last two weeks?
Not at all
Several days
More than half the days
Nearly every day
How often have you had little interest or pleasure in doing things?
Not at all
Several days
More than half the days
Nearly every day
How often have you felt nervous, anxious, or on edge?
Not at all
Several days
More than half the days
Nearly every day
How often have you been unable to stop or control worrying?
Not at all
Several days
More than half the days
Nearly every day
How often have you had trouble relaxing?
Not at all
Several days
More than half the days
Nearly every day
How often have you been so restless that it is hard to sit still?
Not at all
Several days
More than half the days
Nearly every day
How often have you become easily annoyed or irritable?
Not at all
Several days
More than half the days
Nearly every day
How often have you felt afraid as if something awful might happen?
Not at all
Several days
More than half the days
Nearly every day
Additional comments or concerns
Submit
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