Mental Health Questionnaire

Birthday*

Gender

Would you like your results?

Feeling nervous, anxious, or on edge*

Not being able to stop or control worrying*

Worrying too much about different things*

Trouble relaxing*

Being so restless that it's hard to sit still*

Becoming easily annoyed or irritable*

Feeling afraid as if something awful might happen*

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 — or that you are a failure or have let yourself or your family down?*

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

Moving or speaking so slowly that other people could have noticed? Or so fidgety or restless that you have been moving a lot more than usual?*

Thoughts that you would be better off dead, or thoughts of hurting yourself in some way?*