How often do you feel overwhelmed by sadness or hopelessness *

Rarely

Occasionally

Frequently

Almost all the time

Do you experience anxiety or worry that interferes with daily life? *

Not at all

Sometimes

Often

Almost all the time

Have you noticed changes in your sleep patterns (insomnia or sleeping too much)? *

No changes

Some changes

Significant changes

Extreme changes

How often do you feel fatigued or lack energy *

Rarely

Sometimes

Often

Almost all the time

Do you find it hard to concentrate or make decisions? *

No, I'm focused

Sometimes

Often

Almost all the time

Have you lost interest in activities you use to enjoy? *

Not at all

A little

Quite a bit

Completely

Do you have frequent mood swings or feel irritable? *

Rarely

Occasionally

Often

Almost all the time

Have you had repeated thoughts of self-harm or being better off not alive? *

Never

Rarely

Occasionally

Often

Do you find it hard to manage your stress? *

I handle stress well

Sometimes I struggle

Often it's difficult

Almost all the time

Have you talked to a a mental health professional about your feelings or symptoms? *

Yes, recently

Yes, a while ago

No, but I'm considering it

No, I haven't

Full Name *

Email *

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