Processing...
MENTAL HEALTH SCREENING
1
Step 1
2
Step 2
3
Step 3
Sleep Quality (Rate your sleep quality over the past week.)
*
Poor
Fair
Good
Excellent
Feeling Down/Depressed
*
Not at all
Several days
More than half the days
Nearly every day
How often have you felt down, depressed, or hopeless?
Loss of Interest (Anhedonia)
*
True
False
Have you experienced a loss of interest or pleasure in activities?
Next: Step 2
Concentration Difficulty
*
Rate your difficulty concentrating in the past two weeks.
Support Systems
*
Family
Friends
Religious/Spiritual
Therapist
None
Recent Life Changes
(Optional)
Optional: Provide context for current feelings.
Previous
Next: Step 3
Suicidal Ideation
*
Yes
No
Have you had thoughts of hurting yourself or others recently?
Previous
Submit
