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1Little interest or pleasure in doing things

Not at all
0

Several days
1

More than half
2

Nearly every day
3

2Feeling down, depressed, or hopeless

Not at all
0

Several days
1

More than half
2

Nearly every day
3

3Trouble falling or staying asleep, or sleeping too much

Not at all
0

Several days
1

More than half
2

Nearly every day
3

4Feeling tired or having little energy

Not at all
0

Several days
1

More than half
2

Nearly every day
3

5Poor appetite or overeating

Not at all
0

Several days
1

More than half
2

Nearly every day
3

6Feeling bad about yourself or that you are a failure or have let yourself or your family down

Not at all
0

Several days
1

More than half
2

Nearly every day
3

7Trouble concentrating on things, such as reading the newspaper or watching television

Not at all
0

Several days
1

More than half
2

Nearly every day
3

8Moving 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
0

Several days
1

More than half
2

Nearly every day
3

9Thoughts that you would be better off dead, or of hurting yourself

Not at all
0

Several days
1

More than half
2

Nearly every day
3

Personal Information

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Continue to Mental Health Screening

Depression Screening (PHQ-9)

1Little interest or pleasure in doing things

2Feeling down, depressed, or hopeless

3Trouble falling or staying asleep, or sleeping too much

4Feeling tired or having little energy

5Poor appetite or overeating

6Feeling bad about yourself or that you are a failure or have let yourself or your family down

7Trouble concentrating on things, such as reading the newspaper or watching television

8Moving 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

9Thoughts that you would be better off dead, or of hurting yourself

Continue to Anxiety Screening

Anxiety Screening (GAD-7)

1Feeling nervous, anxious, or on edge

2Not being able to stop or control worrying

3Worrying too much about different things

4Trouble relaxing

5Being so restless that it is hard to sit still

6Becoming easily annoyed or irritable

7Feeling afraid, as if something awful might happen

Continue to Contact Preferences

Contact Preferences

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