Kindly answer the following questions. This is a short test used globally and well validated by researchers already in different countries.

Name *

Phone *

Email Address

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Please Answer whether you have been bothered by any of the following during the PAST TWO WEEKS.

1. Little interest or pleasure in doing things *

2. Feeling down, depressed, or hopeless *

3. Having trouble falling asleep or staying asleep, or sleeping too much *

4. Feeling tired or little energy *

5. Having a poor appetite or overeating *

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

7. Having trouble concentrating on things e.g. a newspaper or the television *

8. Moving or speaking so slowly so that other people have noticed, or alternatively being fidgety and restless *

9. Having thoughts that you would be better off dead, or considering hurting yourself in some way *

Depression Score None 0-4  Mild 5-9  Moderately 10-14  Moderately severe 15-19  Severe 20-27

Our Score

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