Please check all that apply.
Are you:
| 1. | Sleeping too little / too much? | Yes
No
|
| 2. | Fatigued / finding yourself with too little energy? | Yes
No
|
| 3. | Crying often? | Yes
No
|
| 4. | Sad? | Yes
No
|
| 5. | Having trouble concentrating? | Yes
No
|
| 6. | Not enjoying life? | Yes
No
|
| 7. | Feeling guilty? | Yes
No
|
| 8. | Slowed down / speeded up? | Yes
No
|
| 9. | Irritable? | Yes
No
|
| 10. | Having thoughts of harming yourself? | Yes
No
|
| 11. | Having trouble functioning? | Yes
No
|


