Answers to this questioner will be forwarded to the Counseling Center e-mail account located in the Health and Wellness Center.
Name: Phone Extension:
1. Over the past two weeks, how often have you been feeling low in energy or slowed down?
None or little of the time Some of the time Most of the time All of the time
2. Over the past two weeks, how often have you been blaming yourself for things?
3. Over the past two weeks, how often have you had poor appetite?
4. Over the past two weeks, how often have you had difficulty falling asleep or staying asleep?
5. Over the past two weeks, how often have you been feeling hopeless about the future?
6. Over the past two weeks, how often have you been feeling blue?
7. Over the past two weeks, how often have you been feeling no interest in things?
8. Over the past two weeks, how often have you had feelings of worthlessness?
9. Over the past two weeks, how often have you thought about wanting to commit suicide?
10. Over the past two weeks, how often have you had difficulty concentrating or making decisions?