Intake

Email *

Over the last 2 weeks, how often have you been bothered by the following problems?

Feeling nervous, anxious, or on edge *

Not being able to stop or control worrying *

Worrying too much about different things *

Trouble relaxing *

Restless, trouble sitting still *

Becoming easily annoyed, irritable *

Feeling afraid as if something awful will happen *

Enter Your Score

Your anxiety is high.

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Email *

Over the last 2 weeks, how often have you been bothered by the following problems?

Little interest or pleasure in doing things *

Feeling down, depressed, or hopeless *

Trouble falling or staying asleep, or sleeping too much *

Feeling tired or having little energy *

Poor appetite or overeating *

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

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

Moving or speaking so slowly that other people could have noticed? Speaking too fast? *

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

Enter Your Score

SEVERE DEPRESSION, contact our office immediately.

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